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二叶式主动脉瓣中重度狭窄患者超声表现及预后的性别差异

Sex difference of echocardiographic characteristics and prognosis in patients with moderate to severe bicuspid aortic stenosis

    摘要
  • 摘要:
    目的 探讨二叶式主动脉瓣（bicuspid aortic valve，BAV）合并中重度主动脉瓣狭窄（aortic stenosis，AS）患者临床表现、超声特征和预后的性别差异。
    方法 回顾性收集2010年7月30日至2015年8月1日于复旦大学附属中山医院确诊为BAV合并中重度AS患者的临床资料，以及心脏超声随访参数。临床随访的复合终点定义为全因死亡或接受手术干预。采用Kaplan-Meier生存曲线和log-rank检验比较不同性别患者复合终点事件的发生风险，采用Cox回归模型分析复合终点事件的独立危险因素。
    结果 共纳入144例患者，男性69例、女性75例，中位年龄60岁。与男性相比，女性患者更年轻58（46，65）岁 vs 61（54，67）岁，P＝0.046，主动脉瓣钙化比例更低（61% vs 81%，P＝0.009），主动脉瓣峰值跨瓣压差更高72（59，88）mmHg vs 63（55，72）mmHg，P＝0.002。左心室重构分型中，女性向心性重构比例高于男性（36% vs 16%，P＝0.006），离心性肥厚比例低于男性（11% vs 29%，P＝0.006）。女性纽约心脏病协会（New York Heart Association，NYHA）心功能分级Ⅲ～Ⅳ级的患者比例多于男性（45% vs 17%，P＜0.001），左室射血分数高于男性68（65，72）% vs 65（60，70）%，P＝0.003。中位随访49个月，Kaplan-Meier生存分析显示，女性复合终点事件的发生风险高于男性（P＜0.001）。复合终点事件的独立危险因素包括女性（HR＝1.74，95%CI 1.02～2.96，P＝0.042）、重度AS（HR＝1.99，95%CI 1.18～3.36，P＝0.010）和NYHA心功能分级Ⅲ～Ⅳ级（HR＝2.08，95%CI 1.24～3.47，P＝0.005）。
    结论 性别对BAV合并中重度AS患者的临床表现、超声特征和预后均有显著影响，可根据性别对此类患者进行特异性超声评估和随访监测。

     

    Abstract:
    Objective To explore the sex difference in clinical manifestations, echocardiographic features and prognosis of patients with bicuspid aortic valve (BAV) combined with moderate to severe aortic stenosis (AS).
    Methods The clinical data and echocardiographic follow-up parameters of patients diagnosed with BAV combined with moderate to severe AS at Zhongshan Hospital, Fudan University, from July 30, 2010 to August 1, 2015 were retrospectively collected. The composite endpoint was defined as all-cause mortality or surgical intervention. Kaplan-Meier survival curves and log-rank tests were used to compare the risk of composite endpoint events between male and female patients, and Cox regression models were used to analyze independent risk factors for composite endpoint events.
    Results A total of 144 patients were included, with 69 males and 75 females, and a median age of 60 years. Compared to males, female patients were younger (5846, 65 years vs 6154, 67 years, P＝0.046), had a lower proportion of aortic valve calcification (61% vs 81%, P＝0.009), and a higher peak transvalvular pressure gradient (7259, 88 mmHg vs 6355, 72 mmHg, P＝0.002). In terms of left ventricular remodeling types, the proportion of concentric remodeling was higher in females than in males (36% vs 16%, P＝0.006), while the proportion of eccentric hypertrophy was lower in females than in males (11% vs 29%, P＝0.006). The proportion of female patients classified as New York Heart Association (NYHA) functional class Ⅲ-Ⅳ was higher than that of males (45% vs 17%, P＜0.001), and left ventricular ejection fraction was higher in females (6865, 72% vs 6560, 70%, P＝0.003). With a median follow-up of 49 months, Kaplan-Meier survival analysis showed that the risk of composite endpoint events was higher in females than in males (P＜0.001). Independent risk factors for composite endpoint events included female (HR＝1.74, 95%CI 1.02-2.96, P＝0.042), severe AS (HR＝1.99, 95%CI 1.18-3.36, P＝0.010), and NYHA functional class Ⅲ-Ⅳ (HR＝2.08, 95% CI 1.24-3.47, P＝0.005).
    Conclusions Sex significantly affects the clinical manifestations, echocardiographic characteristics, and prognosis of patients with BAV combined with moderate to severe AS, suggesting that sex-specific echocardiographic assessment and follow-up monitoring should be conducted for these patients.

     

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