Me. Legget et al., GENDER DIFFERENCES IN LEFT-VENTRICULAR FUNCTION AT REST AND WITH EXERCISE IN ASYMPTOMATIC AORTIC-STENOSIS, The American heart journal, 131(1), 1996, pp. 94-100
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.