Pernambuco Cardiology Emergency Room (PROCAPE), University of Pernambuco, Recife, PE.
Department of Internal Medicine, School of Medical Sciences, State University of Campinas, São Paulo.
J Cardiovasc Med (Hagerstown). 2024 Sep 1;25(9):674-681. doi: 10.2459/JCM.0000000000001654. Epub 2024 Jul 8.
Patients with aortic dissection have a high prevalence of left ventricular structural alterations, including left ventricular hypertrophy (LVH), but little is known about the impact of sex on this regard. This study compared clinical, cardiac, and prognostic characteristics between men and women with aortic dissection.
We retrospectively assessed clinical and echocardiographic characteristics, and 1-year mortality in 367 aortic dissection patients (30% women; 66% with Stanford-A) who underwent echocardiography 60 days before or after the diagnosis of aortic dissection from three Brazilian centers.
Men and women had similar clinical characteristics, except for higher age (59.4 ± 13.4 vs. 55.9 ± 11.6 years; P = 0.013) and use of antihypertensive classes (1.4 ± 1.3 vs. 1.1 ± 1.2; P = 0.024) and diuretics (32 vs. 19%; P = 0.004) in women compared with men. Women had a higher prevalence of LVH (78 vs. 65%; P = 0.010) and lower prevalence of normal left ventricular geometry (20 vs. 10%; P = 0.015) than men. Logistic regression analysis adjusted for confounding factors showed that women were less likely to have normal left ventricular geometry (odds ratio, 95% confidence interval = 0.42, 0.20-0.87; P = 0.019) and were more likely to have LVH (odds ratio, 95% confidence interval = 1.91, 1.11-3.27; P = 0.019). Conversely, multivariable Cox-regression analysis showed that women had a similar risk of death compared to men 1 year after aortic dissection diagnosis (hazard ratio, 95% confidence interval = 1.16, 0.77-1.75; P = 0.49).
In aortic dissection patients, women were typically older, had higher use of antihypertensive medications, and exhibited a greater prevalence of LVH compared with men. However, 1-year mortality after aortic dissection diagnosis did not differ between men and women.
主动脉夹层患者左心室结构改变（包括左心室肥厚[LVH]）的患病率较高，但关于性别对此的影响知之甚少。本研究比较了主动脉夹层患者中男性和女性的临床、心脏和预后特征。
我们回顾性评估了来自巴西三个中心的 367 名主动脉夹层患者（30%为女性；66%为 Stanford-A 型）的临床和超声心动图特征，这些患者在主动脉夹层诊断后 60 天内或之前接受了超声心动图检查。
男性和女性的临床特征相似，但女性年龄较大（59.4±13.4 岁比 55.9±11.6 岁；P=0.013），使用的降压药类别更多（1.4±1.3 类比 1.1±1.2 类；P=0.024），利尿剂更多（32%比 19%；P=0.004）。与男性相比，女性 LVH 发生率更高（78%比 65%；P=0.010），正常左心室几何结构发生率更低（20%比 10%；P=0.015）。经混杂因素调整的 logistic 回归分析显示，女性更不可能有正常的左心室几何结构（比值比，95%置信区间为 0.42，0.20-0.87；P=0.019），更有可能出现 LVH（比值比，95%置信区间为 1.91，1.11-3.27；P=0.019）。相反，多变量 Cox 回归分析显示，女性在主动脉夹层诊断后 1 年的死亡风险与男性相似（风险比，95%置信区间为 1.16，0.77-1.75；P=0.49）。
在主动脉夹层患者中，女性通常年龄较大，使用降压药物的比例较高，与男性相比，LVH 的发生率更高。然而，主动脉夹层诊断后 1 年的死亡率在男性和女性之间没有差异。
