title: Gender differences in factors influencing electrocardiographic findings of left ventricular hypertrophy in severe aortic stenosis.
abstract: We investigated gender differences in factors influencing the electrocardiographic (ECG) findings of left ventricular hypertrophy (LVH) in patients with severe aortic stenosis (AS). The functional and geometric responses of the left ventricle to chronic pressure overload, such as hypertension and AS, have been reported to be different between men and women. However, gender differences in the factors influencing the ECG findings of LVH in pressure overload remain unknown. We conducted a retrospective observational study in consecutive patients with severe AS (aortic valve area (AVA) assessed by cardiac catheterization <1.0 cm(2)) without concomitant significant aortic regurgitation, mitral stenosis and/or regurgitation, conduction disturbance, or myocardial infarction (n = 35 males, 68 females). The ECG criteria were classified into three categories: (1) high voltage by the Sokolow-Lyon index associated with ST-T wave changes (with no digitalis therapy); (2) high voltage alone; and (3) normal. Groups 1 and 2 were defined as LVH on ECG. We compared the ECG findings in relation to the AS severity between genders. Women were older, but there were no significant differences in the prevalence of hypertension, AVA index (AVAI), mean pressure gradient or peak velocity across the AV, LV mass index (LVMI) derived from echocardiography or the distribution of ECG categories between genders. A multiple logistic regression analysis including age, gender, hypertension, AVAI, mean pressure gradient, and LVMI revealed that the LVMI (P = 0.001) and AVAI (P = 0.0434) were significantly related to the distribution of ECG categories. LVMI significantly predicted LVH on ECG in both genders, but AVAI was a predictive factor in only women. ECG LVH in patients with severe AS may be mainly reflected by LVMI in men and by both LVMI and AVAI in women. Factors other than AVA, such as end-stage disease and/or complicating factors such as hypertension, may underlie the observed differences in ECG findings of LVH between men and women.
authors: Department of Cardiology and Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka, 810-8563, Japan, satoshin@kyumed.jp.
authors: Shinji
authors: S
authors: Satoh
authors: Soichiro
authors: S
authors: Omura
authors: Hiroko
authors: H
authors: Inoue
authors: Emiko
authors: E
authors: Ejima
authors: Koutatsu
authors: K
authors: Shimozono
authors: Makiko
authors: M
authors: Hayashi
authors: Takahiro
authors: T
authors: Mori
authors: Katsuhiko
authors: K
authors: Takenaka
authors: Natsumi
authors: N
authors: Kawamura
authors: Kotaro
authors: K
authors: Numaguchi
authors: Etsuo
authors: E
authors: Mori
authors: Akemi
authors: A
authors: Asoh
authors: Toshihiro
authors: T
authors: Nakamura
authors: Koji
authors: K
authors: Hiyamuta
mesh_terms: D000200:Action Potentials; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D006328:Cardiac Catheterization; D016009:Chi-Square Distribution; D015897:Comorbidity; D018618:Echocardiography, Doppler, Color; D018619:Echocardiography, Doppler, Pulsed; D004562:Electrocardiography; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010641:Phenotype; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D012815:Signal Processing, Computer-Assisted
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