Sex-associated differences in left ventricular function in aortic stenosis of the elderly.

Carroll, John D.; Carroll, Eugenia P.; Feldman, Ted; Ward, David M.; Lang, RM; McGaughey, D; Karp, Robert B.

doi:10.1161/01.cir.86.4.1099

Cited by 443 publications

(247 citation statements)

References 39 publications

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“…However, this stability of major hemodynamic features of hypertension across a wide range of age appeared to be attained by different patterns of LV adaptation in women and men. Among women, the age-related increase in systolic blood pressure was offset by increasing LV wall thicknesses and mass, similar to the pattern observed previously with aortic stenosis, 33 with no change in measures of LV endocardial or midwall shortening. In contrast, hypertensive men showed no association between age and LV geometric variables, whereas age was positively associated with LV endocardial and midwall shortening both as absolute values and after adjustment for end-systolic stress.…”

Section: Discussionsupporting

confidence: 84%

Relation of Age to Left Ventricular Function and Systemic Hemodynamics in Uncomplicated Mild Hypertension

et al. 2001

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Abstract-Previous studies in normotensive subjects have shown a slight decline in resting left ventricular pump function and midwall contractility with aging. We examined the relations of age to these variables and to peripheral resistance and vascular stiffness in 272 asymptomatic, unmedicated adults (25 to 80 years old) who had uncomplicated essential hypertension. Cardiac and carotid ultrasound and carotid pressure waveforms were obtained to measure left ventricular dimensions, endocardial and midwall left ventricular shortening, stroke index and cardiac index, end-systolic stress, and pulse pressure/stroke index and ␤, pressure-dependent and independent measures of vascular stiffness, respectively. Endocardial and midwall stress-corrected left ventricular shortening assessed ventricular performance. Cardiac index and TPRI did not change with age in either gender, with age-related increases in systolic pressure offset by increasingly concentric ventricular geometry in women and enhanced ventricular systolic function in men. In contrast to the lack of age-related change in traditional hemodynamic indexes, pulse pressure/stroke volume and ␤ strongly increased with age (PϽ0.001). Thus, in uncomplicated, relatively mild essential hypertension, neither cardiac index nor peripheral resistance is associated with age. This hemodynamic stability is associated with age-related increased concentricity of ventricular geometry in women and increased ventricular performance indexes in hypertensive men. Vascular stiffness progressively increases with age, independent of change in mean pressure or resistance, possibly contributing to increased rates of cardiovascular events in older individuals. Key Words: hypertension, mild Ⅲ echocardiography Ⅲ age Ⅲ ventricular function Ⅲ myocardium A dvancing age, increased left ventricular (LV) mass, and midwall but not endocardial fractional shortening have been shown to predict morbidity and mortality in hypertensive patients. 1-7 Although reduced cardiac output and dysfunction of average myocardial fibers located at the LV midwall occur commonly in hypertension, it is not clear at what stage in the disease these changes develop. 8,9 Previous cross-sectional and some longitudinal studies in hypertensive subjects have demonstrated elevated resting cardiac output (attributed to increased heart rate and/or stroke volume) in young, mildly hypertensive individuals. 10 -12 In contrast, low levels of invasively determined cardiac output and stroke index have been reported in older, often more severely hypertensive individuals. 11,13,14 Nevertheless, uncertainty regarding the evolution of hemodynamic alterations persists. 15 Results from invasive hemodynamic studies may be affected by an "alerting" response that may be greater at younger than older ages. Additionally, previous echocardiographic studies have used endocardial rather than midwall shortening to estimate LV function, thus measuring LV chamber performance accurately but tending to overestimate myocardial function in thick-walled he...

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Section: Discussionsupporting

confidence: 84%

Relation of Age to Left Ventricular Function and Systemic Hemodynamics in Uncomplicated Mild Hypertension

et al. 2001

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“…Krumholz et al [23] showed sex differences in patients with systolic hypertension; men demonstrated maladaptive remodelling with left ventricular dilation and eccentric left ventricular hypertrophy in comparison with more "adaptive" remodelling with concentric hypertrophy and small cavity size in women. Similarly, more marked left ventricular hypertrophy, with small cavities, lower end-systolic wall stress and better preservation of left ventricular ejection performance, has been reported in women compared with men with aortic stenosis [24]. Therefore, it is possible that maladaptive remodelling may be more frequent in men, contributing to their higher mortality.…”

Section: Discussionmentioning

confidence: 94%

Angiotensin‐converting enzyme inhibitors and survival in women and men with heart failure

Keyhan

Chen

Pilote

2007

European J of Heart Fail

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Background: Several randomized controlled trials demonstrate that angiotensin-converting enzyme (ACE) inhibitors improve survival in patients with congestive heart failure (CHF). However, whether ACE inhibitors benefit both sexes is not adequately addressed. Purpose: Our objective was to determine the effectiveness of ACE inhibitors in women with CHF. Methods: The Quebec hospital discharge database was linked with the physician and drug claims database to identify a cohort with a discharge diagnosis of CHF between January 1998 and March 2003. In this retrospective cohort study, subjects who filled a prescription for ACE inhibitors (19,220 exposed) were compared to those who never filled such prescription (8617 non-exposed). The primary outcome was survival by exposure to ACE inhibitors. Main findings: There were 14,693 women (67% exposed) and 13,144 men (72% exposed). The 1 year mortality was 19.5% and 30% in those exposed and non-exposed, respectively. A significant survival benefit was demonstrated in both sexes exposed to ACE inhibitors [adjusted hazard ratio (95% confidence interval): women 0.80 (0.76-0.85); men 0.71 (0.67-0.75)]. Principal conclusions: ACE inhibitors improve survival in both sexes with CHF, but the protective effect appears to be greater in men. Our results support the current recommendations for the management of women with CHF.

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“…Previous studies have identified sex-related differences in cardiac structure and function, with men having higher LV mass 5 and worse systolic [7][8][9] and diastolic function 27,28 than women. Our study is the first to demonstrate that sex also influences regression of LV hypertrophy in a large sample of hypertensive patients with a high prevalence of LV hypertrophy at baseline who were treated in a systematic fashion by structured, blinded drug regimens.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have documented sex-related differences in adaptation to chronic pressure overload, [6][7][8] with women having a tendency towards concentric geometry (ie, increased RWT). We have recently shown in a smaller study that hypertensive patients with concentric LV geometry had greater LV mass reduction after 12 months of antihypertensive therapy than those with normal LV geometry or Sex-related difference in LVH regression JN Bella et al eccentric LV hypertrophy.…”

Section: Female Sex and LV Hypertrophymentioning

confidence: 99%

“…5,6 Furthermore, in Framingham subjects with isolated systolic hypertension, men had more eccentric LV hypertrophy while women had more concentric hypertrophy, 6 possibly accounting for better preserved LV ejection fraction in women with pressure overload. [7][8][9] Several studies have shown that most antihypertensive medications can regress LV hypertrophy, though perhaps with varying efficacy. [10][11][12] However, it remains unclear whether regression of LV hypertrophy differs between sexes.…”

Section: Introductionmentioning

confidence: 99%

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Sex-related difference in regression of left ventricular hypertrophy with antihypertensive treatment: the LIFE study

et al. 2004

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While left ventricular (LV) structure and function differ between hypertensive women and men, it remains unclear whether sex affects regression of LV hypertrophy with antihypertensive treatment. We analysed paired echocardiograms in 500 men and 347 women enrolled in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study at baseline and after 12 months of antihypertensive treatment with either losartan or atenolol. At enrolment, 177 women and 242 men were randomized to losartan-based treatment and 161 women and 247 men were randomized to atenolol-based treatment (sex difference ¼ NS). After 12 months of antihypertensive treatment, blood pressure was lowered similarly in women (152/83 from 174/97 mmHg) and men (149/85 from 173/99 mmHg; both Po0.001, sex difference ¼ NS), without significant change in body weight in either sex. Cardiac output and pulse pressure/stroke volume were equivalently reduced in both sexes (À0.2 vs À0.1 l/min and both -0.20 mmHg/ml/m 2 , respectively; both P ¼ NS). Absolute LV mass change after 12 months of antihypertensive treatment was greater in men than in women (À30 vs À24 g, P ¼ 0.01). However, after adjusting for baseline LV mass and randomized study treatment, LV mass reduction was greater in women than in men (À33 vs À23 g, P ¼ 0.001). LV mass regression was greater in women, by 8.072.8 g, after adjusting for baseline LV mass and randomized study treatment. After consideration of baseline LV mass and randomized study treatment, antihypertensive treatment regressed LV hypertrophy more in women. Further studies are needed to identify the mechanisms and prognostic implications of this sex-related difference.

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Sex-associated differences in left ventricular function in aortic stenosis of the elderly.

Abstract: Background. In aortic stenosis, the response of the left ventricle to pressure overload varies from compensated hypertrophy to overt heart failure.

Cited by 443 publications

References 39 publications

Relation of Age to Left Ventricular Function and Systemic Hemodynamics in Uncomplicated Mild Hypertension

Relation of Age to Left Ventricular Function and Systemic Hemodynamics in Uncomplicated Mild Hypertension

Angiotensin‐converting enzyme inhibitors and survival in women and men with heart failure

Sex-related difference in regression of left ventricular hypertrophy with antihypertensive treatment: the LIFE study

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