{"title":"性别对严重主动脉瓣反流患者左心室反应和生存的影响:来自756例患者长达22年随访的结果。","authors":"Padmini Varadarajan, Ramdas G Pai","doi":"10.3390/medsci11020036","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>We sought to evaluate the effect of gender on biology, therapeutic decisions, and survival in patients with severe aortic regurgitation (AR).</p><p><strong>Background: </strong>Gender affects adaptive response to the presence of valvular heart diseases and therapeutic decisions. The impact of these on survival in severe AR patients is not known.</p><p><strong>Methods: </strong>This observational study was compiled from our echocardiographic database which was screened (1993-2007) for patients with severe AR. Detailed chart reviews were performed. Mortality data were obtained from the Social Security Death Index and analyzed as a function of gender.</p><p><strong>Results: </strong>Of the 756 patients with severe AR, 308 (41%) were women. Over a follow-up of up to 22 years, there were 434 deaths. Women compared to men were older (64 ± 18 vs. 59 ± 17 years, <i>p</i> = 0.0002). Women also had smaller left ventricular (LV) end diastolic dimension (5.2 ± 1.1 vs. 6.0 ± 1.0 cm, <i>p</i> < 0.0001), higher EF (56% ± 17% vs. 52% ± 18%, <i>p</i> = 0.003), higher prevalence of diabetes mellitus (18% vs. 11%, <i>p</i> = 0.006), and higher prevalence of ≥2+ mitral regurgitation (52% vs. 40%, <i>p</i> = 0.0008) despite a smaller LV size. Women were also less likely to receive aortic valve replacement (AVR) (24% vs. 48%, <i>p</i> < 0.0001) compared to men and had a lower survival on univariate analysis (<i>p</i> = 0.001). However, after adjusting for group differences including AVR rates, gender was not an independent predictor of survival. However, the survival benefit associated with AVR was similar in both women and men.</p><p><strong>Conclusions: </strong>This study strongly suggests that female gender is associated with different biological responses to AR compared to men. There is also a lower AVR rate in women, but women derive similar survival benefit as men with AVR. Gender does not seem to affect survival in an independent fashion in patients with severe AR after adjusting for group differences and AVR rates.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"11 2","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2023-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10303455/pdf/","citationCount":"0","resultStr":"{\"title\":\"Gender Effects on Left Ventricular Responses and Survival in Patients with Severe Aortic Regurgitation: Results from a Cohort of 756 Patients with up to 22 Years of Follow-Up.\",\"authors\":\"Padmini Varadarajan, Ramdas G Pai\",\"doi\":\"10.3390/medsci11020036\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>We sought to evaluate the effect of gender on biology, therapeutic decisions, and survival in patients with severe aortic regurgitation (AR).</p><p><strong>Background: </strong>Gender affects adaptive response to the presence of valvular heart diseases and therapeutic decisions. The impact of these on survival in severe AR patients is not known.</p><p><strong>Methods: </strong>This observational study was compiled from our echocardiographic database which was screened (1993-2007) for patients with severe AR. Detailed chart reviews were performed. Mortality data were obtained from the Social Security Death Index and analyzed as a function of gender.</p><p><strong>Results: </strong>Of the 756 patients with severe AR, 308 (41%) were women. Over a follow-up of up to 22 years, there were 434 deaths. Women compared to men were older (64 ± 18 vs. 59 ± 17 years, <i>p</i> = 0.0002). Women also had smaller left ventricular (LV) end diastolic dimension (5.2 ± 1.1 vs. 6.0 ± 1.0 cm, <i>p</i> < 0.0001), higher EF (56% ± 17% vs. 52% ± 18%, <i>p</i> = 0.003), higher prevalence of diabetes mellitus (18% vs. 11%, <i>p</i> = 0.006), and higher prevalence of ≥2+ mitral regurgitation (52% vs. 40%, <i>p</i> = 0.0008) despite a smaller LV size. Women were also less likely to receive aortic valve replacement (AVR) (24% vs. 48%, <i>p</i> < 0.0001) compared to men and had a lower survival on univariate analysis (<i>p</i> = 0.001). However, after adjusting for group differences including AVR rates, gender was not an independent predictor of survival. However, the survival benefit associated with AVR was similar in both women and men.</p><p><strong>Conclusions: </strong>This study strongly suggests that female gender is associated with different biological responses to AR compared to men. There is also a lower AVR rate in women, but women derive similar survival benefit as men with AVR. Gender does not seem to affect survival in an independent fashion in patients with severe AR after adjusting for group differences and AVR rates.</p>\",\"PeriodicalId\":74152,\"journal\":{\"name\":\"Medical sciences (Basel, Switzerland)\",\"volume\":\"11 2\",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-05-23\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10303455/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Medical sciences (Basel, Switzerland)\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.3390/medsci11020036\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Medical sciences (Basel, Switzerland)","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.3390/medsci11020036","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
摘要
目的:我们试图评估性别对严重主动脉反流(AR)患者的生物学、治疗决策和生存的影响。背景:性别影响对瓣膜性心脏病的适应性反应和治疗决策。这些对严重AR患者生存的影响尚不清楚。方法:本观察性研究从我们筛选的严重AR患者的超声心动图数据库(1993-2007)中编译。进行详细的图表回顾。死亡率数据来自社会保障死亡指数，并作为性别的函数进行分析。结果:756例严重AR患者中，308例(41%)为女性。在长达22年的随访中，有434人死亡。女性比男性年龄大(64±18岁比59±17岁，p = 0.0002)。女性左室舒张末期尺寸较小(5.2±1.1 vs. 6.0±1.0 cm, p < 0.0001)， EF较高(56%±17% vs. 52%±18%，p = 0.003)，糖尿病患病率较高(18% vs. 11%， p = 0.006)，尽管左室尺寸较小，但二尖瓣≥2+反流发生率较高(52% vs. 40%， p = 0.0008)。单因素分析显示，与男性相比，女性接受主动脉瓣置换术(AVR)的可能性更低(24%对48%，p < 0.0001)，生存率也更低(p = 0.001)。然而，在调整了包括AVR率在内的组间差异后，性别并不是生存率的独立预测因子。然而，与AVR相关的生存获益在女性和男性中是相似的。结论:本研究强烈表明，与男性相比，女性对AR的生物学反应不同。女性的AVR率也较低，但女性获得的生存益处与男性相似。在调整组差异和AVR率后，性别似乎不会独立影响严重AR患者的生存。
Gender Effects on Left Ventricular Responses and Survival in Patients with Severe Aortic Regurgitation: Results from a Cohort of 756 Patients with up to 22 Years of Follow-Up.
Objectives: We sought to evaluate the effect of gender on biology, therapeutic decisions, and survival in patients with severe aortic regurgitation (AR).
Background: Gender affects adaptive response to the presence of valvular heart diseases and therapeutic decisions. The impact of these on survival in severe AR patients is not known.
Methods: This observational study was compiled from our echocardiographic database which was screened (1993-2007) for patients with severe AR. Detailed chart reviews were performed. Mortality data were obtained from the Social Security Death Index and analyzed as a function of gender.
Results: Of the 756 patients with severe AR, 308 (41%) were women. Over a follow-up of up to 22 years, there were 434 deaths. Women compared to men were older (64 ± 18 vs. 59 ± 17 years, p = 0.0002). Women also had smaller left ventricular (LV) end diastolic dimension (5.2 ± 1.1 vs. 6.0 ± 1.0 cm, p < 0.0001), higher EF (56% ± 17% vs. 52% ± 18%, p = 0.003), higher prevalence of diabetes mellitus (18% vs. 11%, p = 0.006), and higher prevalence of ≥2+ mitral regurgitation (52% vs. 40%, p = 0.0008) despite a smaller LV size. Women were also less likely to receive aortic valve replacement (AVR) (24% vs. 48%, p < 0.0001) compared to men and had a lower survival on univariate analysis (p = 0.001). However, after adjusting for group differences including AVR rates, gender was not an independent predictor of survival. However, the survival benefit associated with AVR was similar in both women and men.
Conclusions: This study strongly suggests that female gender is associated with different biological responses to AR compared to men. There is also a lower AVR rate in women, but women derive similar survival benefit as men with AVR. Gender does not seem to affect survival in an independent fashion in patients with severe AR after adjusting for group differences and AVR rates.
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