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Aortic stenosis and inappropriate myocardial hypertrophy: is there a difference related to gender?

Session Poster Session 4

Speaker Vitor Emer Egypto Rosa

Event : ESC Congress 2019

  • Topic : valvular, myocardial, pericardial, pulmonary, congenital heart disease
  • Sub-topic : Pathophysiology and Mechanisms
  • Session type : Poster Session

Authors : M Bettega (Sao Paulo,BR), VEER Rosa (Sao Paulo,BR), TADA Accorsi (Sao Paulo,BR), JRCF Cordeiro Fernandes (Sao Paulo,BR), GSP Spina (Sao Paulo,BR), ROS Sampaio (Sao Paulo,BR), ASAL Santis (Sao Paulo,BR), FT Tarasoutchi (Sao Paulo,BR)

M. Bettega1 , V.E.E.R. Rosa1 , T.A.D.A. Accorsi1 , J.R.C.F. Cordeiro Fernandes1 , G.S.P. Spina1 , R.O.S. Sampaio1 , A.S.A.L. Santis1 , F.T. Tarasoutchi1 , 1University of Sao Paulo - Sao Paulo - Brazil ,

Valvular Heart Disease – Pathophysiology and Mechanisms

European Heart Journal ( 2019 ) 40 ( Supplement ), 2302

Introduction: Degenerative aortic valve presents distinct patterns according to gender. Inappropriate myocardial hypertrophy in response to severe aortic stenosis (AS) and their clinical repercussions is of recent interest.

Purpose: To evaluate the influence of gender on the pattern of ventricular remodelling in patients with AS and inappropriate ventricular hypertrophy.

Methods: Retrospective study, analysing clinical and echocardiographic characteristics of 145 patients, between 2008 and 2018, with severe aortic stenosis and inappropriate ventricular hypertrophy, defined as septal wall thickness greater than 14 mm.

Results: Women were 42% of the patients, with higher mean age compared to men (75.23±12.78 vs 70.01±12.59 years, p=0.01), lower body surface (1.68±0.17 vs 1.94±0.68 m2, p=0.004), lower ventricular volumes (94.33±32.88x3856±23.81 vs 122.68±43.24x50.34±28.10 ml/m2, p<0.001), increased LV wall thickness (0.65±0.19 vs 0.58±0.10, p<0.001). There were no differences in LV mass (163.22±37.92 vs 170.51±39.08g, p=0.26), septal wall thickness (16.08±1.63 vs 15.71±1.02mm, p=0.24), posterior wall thickness (13.35±1.63 vs 13.67±1.58mm, p=0.23), left ventricular ejection fraction (61.31±10.36 vs 58.92±10.33%, p=0.17), indexed aortic valve area (0.41±0.10 x 0.39±0.08 cm/m2, p=0.23), medium transaortic gradient (57.50±16.42 x 55.08±17.11mmHg, p=0.39), BNP (896.28±1432.44 x 591.09±1007.71pg/ml, p=0.365) and troponin I (7.17±26.36 x 1.01±2.64 mcg/L, p=0.29). The difference between the septum and posterior wall indexed to the body surface was significantly higher in women (1.60±1.06 x 1.10±0.83 mm/m2, p=0.02), as well as the septal wall thickness indexed by the body surface (9.60±1.40 x 8.48±1.30 mm/m2, p<0.001).

Conclusions: Septal wall thickness indexed by body surface and difference between septum and the posterior wall in ventricles with smaller volumes suggest that myocardial hypertrophy in response to severe AS is more severe in women than in men. Since inappropriate myocardial hypertrophy is a predictor of outcomes in AS, it is possible that the optimal timing for valve replacement should be earlier in women.

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