GENDER DIFFERENCES IN LEFT-VENTRICULAR FUNCTION AT REST AND WITH EXERCISE IN ASYMPTOMATIC AORTIC-STENOSIS

In 29 women and 53 men with asymptomatic aortic stenosis, two-dimensio nal (2-D) and Doppler echocardiography were performed at rest and imme diately after treadmill exercise testing to examine gender differences in left ventricular geometry, systolic and diastolic function, functi onal status, and exercise capacity. Aortic stenosis severity was simil ar between men and women. Women reported more functional impairment th an men (88% +/- 14% vs 95% +/- 7%; p=0.02). When indexed to body surfa ce area, women had a smaller end-diastolic volume (39 +/- 14 vs 50 +/- 15 mVm(2); p=0.002), end-systolic volume (13 +/- 6 ml/m(2) vs 18 +/- 9 ml/m(2); p=0.01) and left ventricular mass (73 +/- 26 gm/m(2) vs 84 +/- 21 gm/m(2); p=0.05), but a higher relative wall thickness in systo le (1.5 +/- 0.4 cm vs 1.3 +/- 0.4 cm; p=0.05), and fractional shorteni ng (43% +/- 7% vs 39% +/- 10%; p=0.03). Women had higher early and lat e transmitral velocities than did men (early, 92 +/- 24 cm/sec vs 79 /- 29 cm/sec; p=0.05; late, 97 +/- 30 cm/sec vs 68 +/- 23 cm/sec; p< 0 .0001), a higher time-velocity integral in early diastole (18.2 +/- 4. 8 cm vs 15.1 +/- 4.3 cm; p=0.006), a significantly shorter exercise du ration(4.5 +/- 4.1 minutes vs 8.0 +/- 3.9 minutes; p< 0.0001), a great er degree of functional aerobic impairment (25% +/- 48% vs 2% +/- 33%; p=0.02), and a smaller increase in cardiac output with exercise (5.4 +/- 3.5 L/min vs 8.0 +/- 4.3 L/min; p=0.01), in spite of similar peak heart rate and blood pressure responses. In these asymptomatic subject s with aortic stenosis, women had smaller, relatively hypercontractile ventricles, a different diastolic filling profile, more exercise limi tation, and poorer functional capacity. These findings demonstrate the importance of gender in the response of the left ventricle to chronic pressure overload.