Left ventricular mass regression after aortic valve replacement: Sex differences or effect of different methods of indexation?

Abstract

Background:The influence of sex on regression of left ventricular (LV) hypertrophy (LVH) after aortic valve replacement (AVR) for aortic stenosis (AS) remains elusive.The lack of consensus on how to correct LV mass (LVM) for body size, and different normalcy values, contribute to inconclusive results. Methods:In 164 consecutive patients (mean age 80 ± 4 years, 59% females) with AS, we analyzed LVM (Devereux formula) before and 1 year after AVR (St.Jude Trifecta bio-prosthesis). LVM was indexed to BSA (Du Bois and Gehan formulas), to height 1.7 and height 2.7 . Limits of normalcy were (women and men, respectively): <95 and <115 g/m², BSA-indexed LVM; <60 and <81 g/m, LVM/height 1.7 ; <44 and <48 g/m, LVM/height 2.7 .Results: Women had smaller BSA, but not body mass index, than men. AS severity and incidence of hypertension did not differ. LVM indexed to height 2.7 was greater in women. LVH incidence was similar in males and females. Independently of the indexation method, LVH reduced significantly (P < 0.0001). LVM reduction was greater in women (P < 0.05 for all methods). At follow-up, nearly half the patients, irrespective of sex, showed residual LVH, and diastolic dysfunction. Conclusions:We tested different methods of LVM indexation in AS patients. LVM was similar between men and women. Indexation to height 2.7 gives higher LVM in women because of their shorter stature. LVH prevalence is independent of sex.Irrespective of the indexation method, LVM reduction is greater in females, whereas LVM normalization occurs in equal proportion. Persistent LVH and diastolic dysfunction suggest earlier AVR in elderly.

Aortic stenosis in women

“…Early M-mode and two-dimensional transthoracic echocardiography data suggested that women developed greater LV wall thickness given a similar severity of AS 14 15. However, in a recent study, women and men had similar LV mass (LVM) and prevalence of LV hypertrophy for similar AS severity, regardless whether LVM was indexed for BSA or height 1.7 16. However, with cardiac MRI (CMRI), women often exhibited lower LVM with a smaller LV cavity size, whereas men developed a larger LV cavity and greater LV wall thickness and mass for similar AS severity and comorbidities 17 18.…”