The role of sex and biochemical markers of inflammation in left ventricular remodelling, before and after surgery, in elderly patients with aortic valve stenosis

Stylianos S Kastellanos, Ioannis K Toumpoulis, Constadina Aggeli, Stefanos Zezas, Emmanouil Chlapoutakis, Stamatis Kastellanos, Christodoulos I Stefanadis
Hellenic Journal of Cardiology: HJC 2009, 50 (1): 26-36

INTRODUCTION: 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.

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