title: The role of sex and biochemical markers of inflammation in left ventricular remodelling, before and after surgery, in elderly patients with aortic valve stenosis.
abstract: BACKGROUND
  The aim of this study was to determine whether sex and biochemical markers of inflammation have a role in left ventricular (LV) remodelling after aortic valve replacement in elderly patients with aortic valve stenosis.
  
  
  METHODS
  We studied 52 elderly patients with aortic valve stenosis (32 men, mean age 65 +/- 11 years and 20 women, mean age 68 +/- 9 years). Body surface area did not differ between men and women (1.81 +/- 0.15 versus 1.84 +/- 0.20, respectively). All patients underwent a complete echocardiographic examination for the determination of ejection fraction (EF), LV mass and mass index, peak and mean systolic pressure gradient, aortic valve area, early (E) and late (A) transmitral flow wave velocities and their ratio (E/A), tissue Doppler indexes of the mitral annulus (Sa, Ea, Aa), and the E/Ea ratio. In addition, levels of high sensitivity C-reactive protein (hsCRP), tumour necrosis factor-alpha (TNF-alpha) and monocyte chemoattractant protein-1 (MCP-1) were measured from venous blood samples taken before, and 10 days, 3 months and 6 months after aortic valve replacement.
  
  
  RESULTS
  LV mass decreased from 297 +/- 99.7 g before aortic valve replacement to 210 +/- 67 g 3 months after surgery and to 210 +/- 74 g 6 months after surgery (p<0.001). LV EF did not change significantly (p=0.836). Peak and mean systolic pressure gradients decreased, whereas aortic valve area increased after valve replacement (p<0.001). These changes were similar in men and women. In women Sa was greater (p=0.017) and the E/Ea ratio lower (p=0.025) than in men. The long-term changes in peak and mean pressure gradients, aortic valve area and LV mass after aortic valve replacement were well correlated with the long-term changes in hsCRP, TNF-alpha and MCP-1 in both men and women.
  
  
  CONCLUSIONS
  LV remodelling is similar in elderly men and women with aortic valve disease who have similar body surface area. Although inflammatory markers are not correlated with echocardiographic parameters before aortic valve replacement, a strong correlation exists after operation. This correlation is similar in men and women.
authors.affiliation: Department of Cardiology, Preveza General Hospital, Athens, Greece. castel@otenet.gr
authors.forename: Stylianos S
authors.initials: SS
authors.lastname: Kastellanos
authors.forename: Ioannis K
authors.initials: IK
authors.lastname: Toumpoulis
authors.forename: Constadina
authors.initials: C
authors.lastname: Aggeli
authors.forename: Stefanos
authors.initials: S
authors.lastname: Zezas
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Chlapoutakis
authors.forename: Stamatis
authors.initials: S
authors.lastname: Kastellanos
authors.forename: Christodoulos I
authors.initials: CI
authors.lastname: Stefanadis
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000097:blood / Q000150:complications* / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D018932:Chemokine CCL2 / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*; D020257:Ventricular Remodeling / Q000502:physiology*
chemical_list: D015415:Biomarkers; C111835:CCL2 protein, human; D018932:Chemokine CCL2; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein