Douglas P S, Otto C M, Mickel M C, Labovitz A, Reid C L, Davis K B
Charles A Dana Research Institute, Boston, MA, USA.
Br Heart J. 1995 Jun;73(6):548-54. doi: 10.1136/hrt.73.6.548.
Gender differences in cardiac size have been described in normal humans and animals and in response to pressure overload. To examine the influence of gender on the left ventricular response to pressure overload, clinical, haemodynamic, and echocardiographic data were analysed in the 232 adults with isolated aortic stenosis enrolled in the Balloon Valvuloplasty Registry.
There were 92 men (mean (SD) age 75 (11) years) and 140 women (79 (9) years; P = 0.002). Women had similar symptoms (New York Heart Association class) but lower overall functional status than men (P = 0.008). Catheterisation data showed similar valve area indices (mean (SD) (0.30 (0.09) in men and 0.31 (0.13) cm/m2 in women) but higher peak and mean gradients in women (peak 74 (30) v 63 (22) mm Hg; mean 61 (21) v 54 (18) mm Hg; both P < or = 0.01). On M mode echocardiography women had greater septal and posterior wall thickness but similar cavity diameter, after normalising dimensions to body surface area, resulting in higher relative wall thickness (0.60 (0.20) v 0.50 (0.15); P = 0.0002). Left ventricular mass index was similar in women and men (166 (59) v 159 (50) gm/m2 respectively), however, the prevalence of left ventricular hypertrophy according to sex specific criteria was 54% in men and 81% in women (P = 0.0001). Multiple logistic regression models that adjusted for age, functional status, fractional shortening, and left ventricular systolic pressure found the presence or absence of hypertrophy to be independently associated with gender (P < or = 0.002). Left ventricular systolic function tended to be better in women, who had a higher cardiac index (2.5 (0.8) v 2.3 (0.6) 1/min/m2; P = 0.01), left ventricular peak systolic pressure (211 (36) v 192 (35) mm Hg; P = 0.0001), and echo fractional shortening (32 (13) v 28 (12)%; P = 0.05); however, these differences were reduced when patients with regional wall motion abnormalities were excluded.
In this population of elderly patients undergoing balloon dilatation of isolated aortic stenosis, left ventricular chamber geometry was different in men and women. Because this was a selected population, gender should be further evaluated as a possible determinant of the cardiac adaptation to chronic pressure overload.
在正常人和动物以及压力超负荷情况下，已观察到心脏大小存在性别差异。为研究性别对左心室压力超负荷反应的影响，我们对纳入球囊瓣膜成形术注册研究的232例孤立性主动脉瓣狭窄成年患者的临床、血流动力学和超声心动图数据进行了分析。
研究对象包括92例男性（平均（标准差）年龄75（11）岁）和140例女性（79（9）岁；P = 0.002）。女性症状（纽约心脏协会分级）与男性相似，但总体功能状态低于男性（P = 0.008）。心导管检查数据显示，瓣膜面积指数相似（男性平均（标准差）为0.30（0.09），女性为0.31（0.13）cm/m²），但女性的峰值和平均压力阶差更高（峰值74（30）对63（22）mmHg；平均61（21）对54（18）mmHg；均P≤0.01）。M型超声心动图显示，将尺寸校正为体表面积后，女性的室间隔和后壁厚度更大，但腔径相似，导致相对壁厚更高（0.60（0.20）对0.50（0.15）；P = 0.0002）。女性和男性的左心室质量指数相似（分别为166（59）和159（50）gm/m²），然而，根据性别特异性标准，男性左心室肥厚的患病率为54%，女性为81%（P = 0.0001）。在对年龄、功能状态、缩短分数和左心室收缩压进行校正的多因素逻辑回归模型中，发现左心室肥厚的存在与否与性别独立相关（P≤0.002）。女性的左心室收缩功能往往更好，其心脏指数更高（2.5（0.8）对2.3（0.6）1/min/m²；P = 0.01），左心室峰值收缩压更高（211（36）对192（35）mmHg；P = 0.0001），超声缩短分数更高（32（13）对28（12）%；P = 0.05）；然而，排除有节段性室壁运动异常的患者后，这些差异减小。
在这组接受孤立性主动脉瓣狭窄球囊扩张术的老年患者中，男性和女性的左心室腔几何形态不同。由于这是一个特定人群，性别应作为心脏对慢性压力超负荷适应的一个可能决定因素进一步评估。
