Valvular heart disease
Factors Influencing Left Ventricular Structure and Stress-Corrected Systolic Function in Men and Women With Asymptomatic Aortic Valve Stenosis (a SEAS Substudy)

https://doi.org/10.1016/j.amjcard.2007.09.100Get rights and content

To identify determinants of left ventricular (LV) structure and stress-corrected systolic function in men and women with asymptomatic aortic stenosis (AS), Doppler echocardiography was performed at baseline in 1,046 men and 674 women 28 to 86 years of age (mean 67 ± 10) recruited in the Simvastatin Ezetimibe in Aortic Stenosis (SEAS) study evaluating placebo-controlled combined simvastatin and ezetimibe treatment in AS. LV hypertrophy was less prevalent in women despite older age, higher systolic blood pressure, and smaller aortic valve area/body surface area (all p values <0.05). In logistic regression analyses, LV hypertrophy was independently associated with male gender, severity of AS, hypertension, higher systolic blood pressure, and lower stress-corrected midwall shortening (scMWS) or stress-corrected fractional shortening (scFS; all p values <0.01). In men aortic regurgitation also was a predictor of LV hypertrophy (p <0.05). Women had greater scFS and scMWS when corrected for LV size or geometry (all p values <0.001). In multivariate analyses, female gender predicted 11% greater scFS and 4% greater scMWS independent of age, body mass index, heart rate, aortic valve area, LV mass, relative wall thickness, aortic regurgitation, hypertension, and end-systolic stress (R2 = 0.23 and 0.59, respectively, p <0.001). In conclusion, the major determinants of LV hypertrophy in patients with asymptomatic AS are male gender, severity of AS, and concomitant hypertension. Women have higher stress-corrected indexes of systolic function independent of LV geometry or size, wall stress, older age, or more concomitant hypertension.

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Study population

The present substudy was prospectively planned within the SEAS study that enrolled 1,873 European patients with asymptomatic AS, defined by echocardiography at local study centers as aortic valve thickening and peak transaortic Doppler velocity ≥2.5 and ≤4 m/s. Patients were randomized from January 2001 to February 2004 in 173 hospitals in Norway, Sweden, Finland, Denmark, United Kingdom, Ireland, and Germany to 4-year placebo-controlled combined treatment with ezetimibe 10 mg/day and

Clinical and hemodynamic characteristics

In total 1,046 men and 674 women were included in the present analysis. Women were older, included more obese and hypertensive patients, and had a smaller aortic valve area index (Table 1, Table 2). Prevalence of treated hypertension and type of antihypertensive medication did not differ between men and women. Mitral regurgitation was of grade 1 in 38% and grade 2 in 8% of men and grade 1 in 39%, grade 2 in 13%, and grade 3 in 1% of women (p <0.001). Aortic regurgitation was grade 1 in 45%,

Discussion

Only few studies including a limited number of patients have previously assessed the influence of gender on LV structure and function in patients with mild to moderate asymptomatic AS.17, 18 Thus, the present results add to current knowledge by (1) demonstrating that gender independently influences LV geometry also in patients with mild or moderate asymptomatic AS; (2) identifying partly different covariates of LV hypertrophy in men and women; and (3) demonstrating that gender-related

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The Simvastatin Ezetimibe in Aortic Stenosis (SEAS) echocardiography core laboratory was supported by MSP Singapore Company, LLC, Singapore, a partnership between Merck Co. Inc. and the Schering-Plough Corporation.

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