GENDER IS A DETERMINANT OF THE PATTERN OF REGRESSION OF LEFT VENTRICULAR HYPERTROPHY AFTER AORTIC VALVE REPLACEMENT FOR AORTIC STENOSIS IN ELDERLY PATIENTS
J.C. Cooke, J.J. Smolich, R.E. Peverill, L. Donelan, A. Barr, J. Goldstein, J.S. Gelman*.
Cardiology and Cardiothoracic Surgery Units, Monash Medical Centre and Centre for Heart and Chest Research, Department of Medicine, Monash University, Clayton, Victoria.
Clinical and laboratory evidence suggests that gender influences the development of left ventricular hypertrophy (LVH) secondary to aortic stenosis. However, much less is known about the influence of gender on regression of LVH, particularly in elderly patients. To address this question, the baseline left ventricular mass index (LVMI, gm/m2) was determined in 39 patients with severe aortic stenosis (23 males, 16 females, median age 76 yrs, range 68-82 yrs). Left ventricular end-diastolic (LVED), posterior wall (PW) and interventricular septal (IVS) dimensions were measured in accordance with the American Society of Echocardiography standards. LV mass was determined by the formula 0.832 x [{LVED + PW + IVS}3-{LVED}3+0.6] and was indexed to body surface area. Measurements were repeated at approximately 3 wks and 6 mths follow-up after aortic valve replacement with a MosaicTM Bioprosthesis.
Results: In males, the baseline LVMI (156±30 gm/m2, mean±SD) fell by 11% at the 3 wk follow-up (p<0.01) and by a further 13% at the 6 mth follow-up (p<0.01). By contrast, in females, the baseline LVMI (150±38 gm/m2) decreased by 24% at the 3 wk follow-up (p<0.005), and did not change further at the 6 mth follow-up. On univariate regression analysis of clinical and haemodynamic factors, the percentage reduction in LVMI at the 3 wk follow-up was significantly related to gender (r= 0.38, p<0.04) and bioprosthesis size (r= -0.36, p<0.05), but gender was the only independent predictor on multivariate analysis.
Conclusions: These findings suggest that, in elderly patients, gender is a determinant of the pattern or regression of MVH following aortic valve replacement for severe aortic stenosis.
