Liao Y, Cooper R S, Mensah G A, McGee D L
Department of Preventive Medicine and Epidemiology, Loyola University Medical Center, Maywood, Ill 60153, USA.
Circulation. 1995 Aug 15;92(4):805-10. doi: 10.1161/01.cir.92.4.805.
Echocardiographically determined left ventricular hypertrophy (LVH) has a well-demonstrated association with cardiovascular morbidity and mortality. However, whether or not there is a sex differential in the impact of LVH on mortality has never been systematically explored.
This study enrolled 436 consecutive black patients (163 men and 273 women) free of angiographic coronary artery disease from a hospital registry. LVH (left ventricular [LV] mass/body surface area > or = 117 g/m2 in men and > or = 104 g/m2 in women) was present in 84 men (52%) and 119 women (44%). During a mean of 5 years' follow-up (range, 0 to 9), 49 patients (26 men and 23 women) died. The mortality rate was 5.40 per 100 patient-years in men with LVH and 2.58 in men without LVH (crude relative risk [RR] = 2.09) and 3.21 and 0.66, respectively, in women (RR = 4.87). In Cox regression analysis, adjusting for age, hypertension, and ejection fraction, the RR of total death for LVH versus non-LVH was 2.0 (95% confidence interval [CI], 0.8 to 5.0) in men and 14.3 (95% CI, 1.6 to 11.7) in women. For cardiac death, RR was 1.3 (95% CI, 0.4 to 3.7) and 7.5 (95% CI, 1.6 to 33.8) in men and women, respectively. Analyses using LV mass indexed by height or height with the use of different LVH cut points, comparing patients in the highest sex-specific tertile of mass index to those in the lower two tertiles, and the use of LV mass indexes as continuous variables similarly demonstrated a greater increase in risk of either fatal end point among women than men.
These findings indicate a sex difference in the contribution of LV mass and hypertrophy to mortality in the absence of coronary artery disease.
超声心动图测定的左心室肥厚（LVH）与心血管疾病的发病率和死亡率之间存在明确关联。然而，LVH对死亡率的影响是否存在性别差异从未得到系统探讨。
本研究从医院登记处纳入了436例连续的无血管造影冠状动脉疾病的黑人患者（163例男性和273例女性）。84例男性（52%）和119例女性（44%）存在LVH（男性左心室[LV]质量/体表面积≥117 g/m²，女性≥104 g/m²）。在平均5年的随访期（范围0至9年）内，49例患者（26例男性和23例女性）死亡。LVH男性的死亡率为每100患者年5.40例，无LVH男性为2.58例（粗相对风险[RR]=2.09），女性分别为3.21例和0.66例（RR = 4.87）。在Cox回归分析中，校正年龄、高血压和射血分数后，男性中LVH与非LVH相比的总死亡RR为2.0（95%置信区间[CI]，0.8至5.0），女性为14.3（95%CI，1.6至11.7）。对于心源性死亡，男性和女性的RR分别为1.3（95%CI，0.4至3.7）和7.5（95%CI，1.6至33.8）。使用按身高或身高指数化的LV质量，采用不同的LVH切点进行分析，将质量指数最高的性别特异性三分位数患者与较低的两个三分位数患者进行比较，并将LV质量指数作为连续变量使用，同样显示女性中任一致死终点的风险增加幅度大于男性。
这些发现表明，在无冠状动脉疾病的情况下，LV质量和肥厚对死亡率的影响存在性别差异。
