Sex-differences in aortic stenosis: Effect on functional capacity and prognosis.
Aortic stenosis
Exercise treadmill test
Functional capacity
Heart rate response
Metabolic equivalents
Prognosis
Sex-differences
Journal
International journal of cardiology
ISSN: 1874-1754
Titre abrégé: Int J Cardiol
Pays: Netherlands
ID NLM: 8200291
Informations de publication
Date de publication:
01 04 2020
01 04 2020
Historique:
received:
11
09
2019
revised:
05
11
2019
accepted:
25
11
2019
pubmed:
10
12
2019
medline:
15
5
2021
entrez:
10
12
2019
Statut:
ppublish
Résumé
The patterns of left ventricular (LV) remodeling in aortic stenosis (AS) are different in men and women. We aimed to assess whether there were also sex differences in measurements obtained on exercise testing. Echocardiography and ETT (modified Bruce) were performed at presentation in 316 patients with moderate or severe AS. An early rapid rise in heart rate (RR-HR) during ETT was defined as achieving at least 85% of target heart rate or ≥50% increase from baseline within the first 6 min. Mean age was 66 ± 12 years in men (n = 212) and 65 ± 12 years in women (n = 104) (p = NS). Men walked longer than women on the treadmill (10.4 ± 4.3 vs. 8.2 ± 4.2 min, p < 0.001) and achieved higher METs (9.2 ± 4.5 vs. 7.6 ± 4.3, p < 0.001), but both sexes achieved similar levels of peak heart rate and blood pressure. During a mean follow up of 34.9 ± 34.6 months, 29 deaths occurred (20 in men and 9 in women, p = 0.821). Age and body mass index were strong determinants of lower METs in men, but not in women, while Zva was a determinant in women but not in men. RR-HR was a strong determinant of lower METs in both sexes. Event-free survival was significantly lower in men with RR-HR but not in women. Exercise capacity was lower in women than men, and the determinants of exercise capacity differed. An RR-HR was a strong determinant of lower METs in both sexes, but predicted all-cause mortality only in men.
Sections du résumé
BACKGROUND
The patterns of left ventricular (LV) remodeling in aortic stenosis (AS) are different in men and women. We aimed to assess whether there were also sex differences in measurements obtained on exercise testing.
METHODS
Echocardiography and ETT (modified Bruce) were performed at presentation in 316 patients with moderate or severe AS. An early rapid rise in heart rate (RR-HR) during ETT was defined as achieving at least 85% of target heart rate or ≥50% increase from baseline within the first 6 min.
RESULTS
Mean age was 66 ± 12 years in men (n = 212) and 65 ± 12 years in women (n = 104) (p = NS). Men walked longer than women on the treadmill (10.4 ± 4.3 vs. 8.2 ± 4.2 min, p < 0.001) and achieved higher METs (9.2 ± 4.5 vs. 7.6 ± 4.3, p < 0.001), but both sexes achieved similar levels of peak heart rate and blood pressure. During a mean follow up of 34.9 ± 34.6 months, 29 deaths occurred (20 in men and 9 in women, p = 0.821). Age and body mass index were strong determinants of lower METs in men, but not in women, while Zva was a determinant in women but not in men. RR-HR was a strong determinant of lower METs in both sexes. Event-free survival was significantly lower in men with RR-HR but not in women.
CONCLUSION
Exercise capacity was lower in women than men, and the determinants of exercise capacity differed. An RR-HR was a strong determinant of lower METs in both sexes, but predicted all-cause mortality only in men.
Identifiants
pubmed: 31813683
pii: S0167-5273(19)34571-1
doi: 10.1016/j.ijcard.2019.11.136
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
130-134Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2019 Elsevier B.V. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest There are no conflicts of interest for any authors.