Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Department of Internal Medicine, Division of Cardiology, National Taiwan University Hospital, Taipei, Taiwan.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
Mayo Clin Proc. 2021 Aug;96(8):2145-2156. doi: 10.1016/j.mayocp.2020.11.033.
To examine contemporary clinical differences between men and women with hemodynamically significant chronic aortic regurgitation (AR).
We retrospectively identified 1072 consecutive patients with moderate to severe or severe AR diagnosed between February 21, 2004, and April 29, 2019. Echocardiographic data, aortic valve surgical intervention (AVS), and all-cause death were analyzed.
At baseline, the 189 women in the study group were older than the 883 men (mean ± SD age, 64±18 years vs 58±17 years), had more advanced symptoms, and had larger left ventricular end-systolic dimension index (LVESDi) (all P<.001) despite similar AR severity. An LVESDi of greater than 20 mm/m was noted in 60 of 92 asymptomatic women (65%) vs 225 of 559 asymptomatic men (40%) (P<.001). Median follow-up was 5.6 years (interquartile range, 2.5 to 10.0 years). Female sex was associated with less AVS (P=.009), and overall 10-year survival was better in men (76%±2%) than in women (64%±5%) (P=.004). However, 10-year post-AVS survival was similar between the sexes (P=.86), and women had better left ventricular reverse remodeling than men regarding end-diastolic dimension (P=.02). Multivariable independent predictors of death were age, advanced symptoms, LVESDi, ejection fraction, and AVS (all P≤.03) but not female sex. When compared with the age-matched US population, women exhibited a 1.3-fold increased relative risk of death (P=.0383) while men had similar survival (P=.11).
In contemporary practice, women with AR continue to exhibit an overall survival penalty not related to female sex but to late referral markers, including more advanced symptoms, larger LVESDi, and less AVS. Nonetheless, women in our study exhibited outstanding post-AVS left ventricular remodeling and had good post-AVS survival, a step forward toward closing the sex-related mortality gap. The high percentage of LVESDi of 20 mm/m or greater in asymptomatic women represents a window of opportunity for advanced-symptom prevention and timely AR surgical correction that may close the mortality gap.
研究血流动力学意义上的慢性主动脉瓣反流（AR）男性和女性患者的当代临床差异。
我们回顾性地确定了 2004 年 2 月 21 日至 2019 年 4 月 29 日期间诊断为中度至重度或重度 AR 的 1072 例连续患者。分析了超声心动图数据、主动脉瓣手术干预（AVS）和全因死亡。
在基线时，研究组的 189 名女性比 883 名男性年龄更大（平均年龄±标准差，64±18 岁比 58±17 岁），症状更严重，左心室收缩末期内径指数（LVESDi）更大（均 P<.001），尽管 AR 严重程度相似。92 名无症状女性中有 60 名（65%）LVESDi 大于 20mm/m，而 559 名无症状男性中有 225 名（40%）（P<.001）。中位随访时间为 5.6 年（四分位距，2.5 至 10.0 年）。女性发生 AVS 的比例较低（P=.009），男性 10 年生存率（76%±2%）优于女性（64%±5%）（P=.004）。然而，男女之间的 AVS 后 10 年生存率相似（P=.86），且女性的舒张末期内径的左心室逆向重构优于男性（P=.02）。死亡的多变量独立预测因素是年龄、晚期症状、LVESDi、射血分数和 AVS（均 P≤.03），但不是女性性别。与年龄匹配的美国人群相比，女性的死亡相对风险增加了 1.3 倍（P=.0383），而男性的生存率相似（P=.11）。
在当代实践中，AR 女性的整体生存率仍然存在不利影响，这与女性性别无关，而是与晚期就诊指标有关，包括更严重的症状、更大的 LVESDi 和较少的 AVS。尽管如此，我们研究中的女性表现出出色的 AVS 后左心室重构，并且 AVS 后生存率良好，这是缩小与性别相关的死亡率差距的重要一步。无症状女性中 LVESDi 为 20mm/m 或更大的比例较高，为预防晚期症状和及时进行 AR 手术矫正提供了机会，可能会缩小死亡率差距。
