中国临床医学2025，Vol.32Issue(5)：785-792,8.DOI:10.12025/j.issn.1008-6358.2025.20250347
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
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 curve and log-rank test 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(58[46,65]years vs 61[54,67]years,P=0.046),had a lower proportion of aortic valve calcification(61.1%vs 81.1%,P=0.009),and a higher peak transvalvular pressure gradient(72[59,88]mmHg vs 63[55,72]mmHg,P=0.002).In terms of left ventricular remodeling types,the proportion of concentric remodeling was higher in females than in males(36.0%vs 15.9%,P=0.006),while the proportion of eccentric hypertrophy was lower in females than in males(10.7%vs 29.0%,P=0.006).The proportion of female patients classified as New York Heart Association(NYHA)functional classⅢ-Ⅳwas higher than that of males(45.3%vs 17.4%,P＜0.001),and left ventricular ejection fraction was higher in females(68%[65%,72%]vs 65%[60%,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 classⅢ-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.关键词
二叶式主动脉瓣/主动脉瓣狭窄/性别差异Key words
bicuspid aortic valve/aortic stenosis/sex difference分类
医药卫生引用本文复制引用
冯宝琪,陆飞炜,杨喆清,李军,潘翠珍,舒先红,汪咏莳..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[J].中国临床医学,2025,32(5):785-792,8.基金项目
国家自然科学基金(82071991).Supported by National Natural Science Foundation of China(82071991). （82071991）
