性别是否会影响重度主动脉瓣狭窄的治疗指征及长期预后？
Does Gender Influence the Indication of Treatment and Long-Term Prognosis in Severe Aortic Stenosis?
作者信息
Gil Llopis Celia, Valls Serral Amparo, Roldán Torres Ildefonso, Contreras Tornero Maria Belén, Cuevas Vilaplana Ana, Sorribes Alonso Adrian, Escribano Escribano Pablo, Gimeno Tio Pau, Galiana Talavera Esther, Geraldo Martínez Juan, Gramage Sanchis Paula, Mateos Alberto Hidalgo, Mora Llabata Vicente
机构信息
Department of Cardiology, Hospital Universitario Dr Peset, 46017 Valencia, Spain.
出版信息
J Cardiovasc Dev Dis. 2023 Jan 22;10(2):38. doi: 10.3390/jcdd10020038.
INTRODUCTION
It is a matter of controversy whether the therapeutic strategy for severe aortic stenosis (AS) differs according to gender.
METHODS
Retrospective study of patients diagnosed with severe AS (transvalvular mean gradient ≥ 40 mmHg and/or aortic valvular area < 1 cm) between 2009 and 2019. Our aim was to assess the association of sex on AVR or medical management and outcomes in patients with severe AS.
RESULTS
452 patients were included. Women (51.1%) were older than men (80 ± 8.4 vs. 75.8 ± 9.9 years; < 0.001). Aortic valve replacement (AVR) was performed less frequently in women (43.4% vs. 53.2%; = 0.03), but multivariate analyses showed that sex was not an independent predictor factor for AVR. Age, Charlson index and symptoms were predictive factors (OR 0.81 [0.82-0.89], OR 0.81 [0.71-0.93], OR 22.02 [6.77-71.64]). Survival analysis revealed no significant association of sex within all-cause and cardiovascular mortalities (log-rank = 0.63 and = 0.07). Cox proportional hazards analyses showed AVR (HR: 0.1 [0.06-0.15]), Charlson index (HR: 1.13 [1.06-1.21]) and reduced LVEF (HR: 1.9 [1.32-2.73]) to be independent cardiovascular mortality predictors.
CONCLUSIONS
Gender is not associated with AVR or long-term prognosis. Cardiovascular mortality was associated with older age, more comorbidity and worse LVEF.
引言
重度主动脉瓣狭窄（AS）的治疗策略是否因性别而异仍存在争议。
方法
对2009年至2019年间诊断为重度AS（跨瓣平均压差≥40 mmHg和/或主动脉瓣面积<1 cm²）的患者进行回顾性研究。我们的目的是评估性别与重度AS患者接受主动脉瓣置换术（AVR）或药物治疗及其预后之间的关联。
结果
共纳入452例患者。女性（51.1%）比男性年龄更大（80±8.4岁 vs. 75.8±9.9岁；P<0.001）。女性接受AVR的比例较低（43.4% vs. 53.2%；P = 0.03），但多因素分析显示性别不是AVR的独立预测因素。年龄、Charlson指数和症状是预测因素（OR 0.81[0.82 - 0.89]，OR 0.81[0.71 - 0.93]，OR 22.02[6.77 - 71.64]）。生存分析显示，在全因死亡率和心血管死亡率方面，性别无显著关联（对数秩检验P = 0.63和P = 0.07）。Cox比例风险分析显示，AVR（HR：0.1[0.06 - 0.15]）、Charlson指数（HR：1.13[1.06 - 1.21]）和左心室射血分数降低（HR：1.9[1.32 - 2.73]）是心血管死亡的独立预测因素。
结论
性别与AVR或长期预后无关。心血管死亡率与年龄较大、合并症较多和左心室射血分数较差有关。
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