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Cited by 488Cardiac Valve Diseases and TreatmentsCardiovascular Function and Risk FactorsAortic Disease and Treatment Approaches

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

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Carroll, J D, Carroll, E P, Feldman, T, Ward, D M, Lang, R M, McGaughey, D, Karp, R B·1992·Circulation
DOI 10.1161/01.cir.86.4.1099
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Abstract

BACKGROUND: In aortic stenosis, the response of the left ventricle to pressure overload varies from compensated hypertrophy to overt heart failure. The determinants of left ventricular adaptation are poorly understood. METHODS AND RESULTS: Left ventricular function was compared to assess the role of sex in 34 women and 29 men 60 years or older with both hemodynamic and echocardiographic data characteristic of severe aortic stenosis and no important coronary artery disease. Despite a similar degree of left ventricular outflow obstruction in women versus men (aortic valve area 0.54 +/- 0.20 versus 0.59 +/- 0.19 cm2, NS), the left ventricle of women had a greater fractional shortening (37 +/- 12 versus 25 +/- 12%, p = 0.001), achieved a smaller end-systolic chamber size (1.82 +/- 0.64 versus 2.17 +/- 0.65 cm/m2, p = 0.04), and generated more pressure (210 +/- 35 versus 182 +/- 29 mm Hg, p = 0.001) with a greater maximum positive dP/dt (2.153 +/- 794 versus 1,595 +/- 384 mm Hg/sec, p = 0.02). The men had a lower cardiac index (2.12 +/- 0.59 versus 2.49 +/- 0.63 l/min/m2, p = 0.02), higher mean pulmonary artery pressure (35 +/- 13 versus 27 +/- 10 mm Hg, p = 0.01), and shorter ejection period (340 +/- 40 versus 370 +/- 40 msec, p = 0.02). Women and men were equally symptomatic. Supernormal left ventricular ejection performance was present in 41% of the women and only 14% of the men (p = 0.002). This subgroup of women had a small, thick-walled chamber (end-diastolic radius to thickness ratio, 1.58 +/- 0.52 versus 2.45 +/- 0.51 in control women, p = 0.01) with low end-systolic wall stress. Subnormal ejection performance was present in 64% of the men and only 18% of the women (p = 0.002). This subgroup of men had an increased chamber size and high end-systolic wall stress compared with control men. Greater left ventricular mass was present in men compared with women (211 +/- 55 versus 179 +/- 55 g/m2, p = 0.03). CONCLUSIONS: Sex is a factor in left ventricular adaptation to valvular aortic stenosis in adults 60 years or older.

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Crossref · 10.1161/01.cir.86.4.1099

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33 of 33 references verified0 citation errors · 0 not checkable

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  • For the same degree of AS, women tend to develop predominantly concentric remodelling/hypertrophy, whereas men are more prone to eccentric hypertrophy.

    “For the same degree of AS, women tend to predominantly develop concentric remodelling/hypertrophy, whereas men are more prone to developing eccentric hypertrophy116.”

    From Calcific aortic stenosis (2016) · cites this paper as [116]

    The Abstract and Results report similar severity of aortic stenosis in the elderly women and men studied, with women more often having small, thick-walled ventricles and men more often having larger, more dilated ventricles. The Results do not establish that men generally had eccentric hypertrophy: the overall sex difference in end-diastolic chamber radius-to-wall-thickness ratio was not significant. The claim captures the tendency in chamber appearance but states the men's hypertrophy pattern more definitively than the paper supports. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • The pattern and magnitude of LV hypertrophic remodelling in AS are influenced by AS severity and by age, sex, genetic factors, metabolic factors, and coexisting coronary artery disease or hypertension.

    “The pattern and magnitude of LV hypertrophic remodelling is influenced not only by AS severity but also by several other factors including age, sex, genetic factors, metabolic factors and the coexistence of coronary artery disease or hypertension116–119.”

    From Calcific aortic stenosis (2016) · cites this paper as [116]

    The Summary reports that sex affects the pattern of left ventricular hypertrophy in aortic stenosis, and the ‘Response of the Left Ventricle to Aortic Stenosis’ section links valve obstruction to hypertrophy. The paper studies patients aged 60 or older but says an age-related contribution is only possible; it does not establish effects of genetic or metabolic factors, coexisting coronary artery disease, or coexisting hypertension on remodelling in these patients. Page numbers are not provided for these passages in our copy. (LLM, conf=0.89)

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Research works printed but not linked: 6

  1. [7]7. Borow KA, Colan SD, Neumann A: Altered left ventricular mechanics in patients with valvular aortic stenosis and coarctation of the aorta: Effects on systolic performance and late outcome. Circulation 1985;72:515-522
  2. [13]13. Devereux RB, Reichek N: Echocardiographic determination of left ventricular mass in man. Circulation 1977;55:613-618
  3. [16]16. Zak R: Factors controlling cardiac growth, in Zak R (ed): Growth of the Heart in Health and Disease. New York, Raven Press, 1984, pp 165-185
  4. [23]23. Mann DL, Spann JF, Cooper G: Basic mechanisms and models in cardiac hypertrophy: II. Hypertrophy into failure. Mod Concepts Cardiovasc Dis 1988;57:13-17
  5. [32]32. Parker DP, Kaplan MA, Connolly JE: Coexistent aortic valvular and functional hypertrophic subaortic stenosis: Clinical, physio- logic and angiographic aspects. Am J Cardiol 1979;24:307-317
  6. [39]39. Roberts WC, Perloff JK, Costantino T: Severe valvular aortic stenosis in patients over 65 years of age: A clinicopathologic study. Am J Cardiol 1971;27:497-506

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Authors
Carroll, J. D., Carroll, E. P., Feldman, T., Ward, D. M., Lang, R. M., McGaughey, D., & Karp, R. B.
Affiliations
University of Chicago (US)
ORCID
Venue
Circulation
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
1992-10
Volume
86
Issue
4
Pages
1099-1107
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
DOI
10.1161/01.cir.86.4.1099
OpenAlex
W2080150476
Cited by
488
References
33
Citations by year
2026: 5 · 2025: 10 · 2024: 4 · 2023: 8 · 2022: 14 · 2021: 11 · 2020: 25 · 2019: 20 · 2018: 15 · 2017: 22 · 2016: 20 · 2015: 13 · 2014: 16 · 2013: 19 · 2012: 24
FWCI
4.03
Type
journal article
Language
en
Open access
Locations
  • Circulation (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Aortic Disease and Treatment Approaches
Keywords
aortic stenosis, sex differences, left ventricular function, older adults, pressure overload, left ventricular hypertrophy, left ventricular outflow tract obstruction, end-systolic wall stress, cardiac index, pulmonary artery pressure, men, heart failure, echocardiography, hemodynamics, ejection time
MeSH terms
Aged, Aging, Aortic Valve Stenosis, Echocardiography, Female, Hemodynamics, Humans, Male, Middle Aged, Reference Values, Sex Characteristics, Ventricular Function, Left

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