Gender differences in patients with severe aortic stenosis: impact on preoperative left ventricular geometry and function, as well as early postoperative morbidity and mortality

Objective: In patients with severe aortic stenosis, we studied the impact o f gender on preoperative left ventricular geometry and function, as well as on early postoperative mortality and morbidity. Methods: Prospective Doppl er echocardiographic evaluation was performed in 99 female patients and: 96 males. Results: The patients had severe aortic stenosis and the mean press ure gradients were similar in females and males. Left ventricular diastolic volume adjusted for body surface area (BSA) was larger in males, 55 +/- 7. 4 ml/m(2) versus 43 +/- 13.1 ml/m(2) (mean It standard deviation: P = 0.000 1). The ejection fraction was similar in females (55 +/- 14%) and males (55 +/- 13%), and patients of both sexes bad significantly lower stroke volume and cardiac index than healthy controls. The relative wall thickness (wall thickness/diastolic diameter ratio) was higher (P = 0.03) in females (0.47 +/- 0.10) than in males (0.43 rt 0.10) Consequently, the diastolic diamete r/wall thickness ratio (a substitute for wall tension) was higher (P = 0.02 ) in males (4.2 +/- 0.99) than in females (3.9 +/- 0.80). Compared with sur vivors, patients who died within 30 days of the operation (n = 17, 11 femal es) had a smaller body surface area (1.70 +/- 0.19 vs. 1.82 +/- 0.19 m(2), P = 0.012), smaller left ventricular outflow tract (20.8 +/- 0.21 vs. 22.0 +/- 0.22 mm. P = 0.023), higher incidence of abnormal intraventricular flow velocity (33 vs. 8%, P = 0.018) and increased relative wall thickness (0.5 2 +/- 0.17 vs. 0.45 +/- 0.09 P = 0.039). Gender was of no independent impor tance for early mortality when age and left ventricular outflow tract diame ter were accounted for. Conclusions: Cardiac adaptation to aortic stenosis seems to be influenced by gender, males presenting larger left ventricular volumes and higher wall tension. The echocardiographic findings of a narrow left ventricular outflow tract, abnormally increased intraventricular velo city and increased relative wall thickness identified patients with increas ed risk of early postoperative mortality, However gender had no independent impact on early postoperative outcome. (C) 1999 Elsevier Science B.V. All rights reserved.