GENDER DIFFERENCES OF CORONARY HEART DISEASE PATIENTS WITH POSTINFARCTION CARDIOSCLEROSIS AND CHRONIC MITRAL REGURGITATION BY THE DATA OF CORONARY ANGIOGRAPHY REGISTRY

Aim. To reveal gender differences of clinical and functional parameters in postmyocardial infarction patients with chronic mitral regurgitation by data of coronary angiography Registry.

Material and methods. Among 15283 patients of Coronary angiography Registry© evaluated from 1991 to 2012 we selected end assessed clinical and functional parameters of 350 men and 53 women with Q-wave myocardial infarction and moderate or severe mitral regurgitation and signs of scars detected by echocardiography.

Results. Comparing to the men, women had lower hemoglobin level (135,5±11,3 vs 148,3±14,2 g/l, р<0,001) and rate of smokers (9,8 vs 62,6%, р<0,001). The prevalence of hypothyroidism (29,7 vs 9,6%, р=0,001) and severe MR (17,0 vs 9,1%, р=0,038) were higher in women. They had higher indexes of left atrium size (25,1±2,9 vs 23,7±3,2 mm/m2, р=0,008), left ventricular (LV) posterior wall thickness (6.0±0.7 vs 5,2±0,8 mm/m2, р<0,001), lower extent of LV wall motion abnormalities (28,7±14,7 vs 33,5±14,9%, р=0,036) and higher LV ejection fraction (47,3±8,2 vs 43,9±9,2%, р=0,013). The localization of myocardial scars and coronary stenosis did not differ between men and women. According to the results of multivariate analysis, female gender was independently associated with greater index of LV posterior wall thickness (OR 3,215; CI 1,781–5,804; р<0,001), hypothyroidism (OR 3,070; CI 0,994–9,483; р=0,050), greater body mass index (OR 1,17; CI 1,042–1,317; р=0,008), smoking (ОR 0,056; CI 0,013–0,244; р<0,001) and lower hemoglobin level (OR 0,927; CI 0,890–0,966; р<0,001).

Conclusion. There are gender differences in clinical and functional parameters of postmyocardial infarction patients with chronic mitral regurgitation: more severe LV remodeling in women.

1. Barna ON. Gender aspects of treatment of coronary artery disease. News of medicine and pharmacy 2009; 274: 8375–400. Russian (Барна О.Н. Гендерные аспекты лечения ишемической болезни сердца. Новости медицины и фармации 2009; 274: 8375–400).

2. Vahanian A, Baumgartner H, Bax J, et al. Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. Eur Heart J 2007; 28: 230–68.

3. Yaroslavskaya EI, Kuznetsov VA, Pushkarev GS, et al. Mitral regurgitation in post￾myocardial infarction patients. Materials of European Society of cardiology, Munich 2012. Eur Heart J 2012; 33 (Abstract Supplement): 923. Russian (Ярославская Е.И., Кузнецов В.А., Пушкарев Г. С. и др. Митральная регургитация у больных с постинфарктным кардиосклерозом. Материалы Европейского Конгресса кардиологов. Мюнхен 2012. Eur Heart J 2012; 33 (Abstract Supplement): 923).

4. Yaroslavskaya EI, Kuznetsov VA, Pushkarev GS, et al. Association of chronic mitral regurgitation with right coronary artery stenoses in post-myocardial infarction patients. International Journal of Intervention Cardiology 2012; 30: 39–45. Russian (Ярославская Е.И., Кузнецов В.А., Пушкарев Г. С. и др. Связь хронической ишемической митральной регургитации с локализацией коронарных стенозов у больных с постинфарктным кардиосклерозом. Международный журнал интер- венционной кардиологии 2012; 30: 39–45).

5. Kuznetsov VA, Zyrjanov IP, Kolunin GV, et. al. Certificate of State registration database № 2010620076, registered in Register of database at 1 of February 2010. Russian (Кузнецов В.А., Зырянов И.П., Колунин Г.В. и др. Свидетельство о государст- венной регистрации базы данных № 2010620076, зарегистрировано в Реестре базы данных 1 февраля 2010 года).

6. Lang RM, Bierig M, Devereux RB, et al.; American Society of Echocardiography’s Nomenclature and Standards Committee; Task Force on Chamber Quantification; American College of Cardiology Echocardiography Committee; American Heart Association; European Association of Echocardiography, European Society of Cardiology. Recommendations for chamber quantification. Eur J Echocardiogr 2006; 7 (2): 79–108.

7. Shiller N, Osipov MA. Clinical echocardiogriography. Practice; 2005. 344 p. Russian (Шиллер Н., Осипов М.А. Клиническая эхокардиография. Практика; 2005: 344 c).

8. Pierard LA, Carabello BA. Ischaemic mitral regurgitation: pathophysiology, outcomes and the conundrum of treatment. Eur Heart J 2010; 31 (24): 2996–3005.

9. Borger MA, Alam A, Murphy PM, et al. Chronic ischemic mitral regurgitation: repair, replace or rethink? Ann Thorac Surg 2006; 81 (3): 1153–61.

10. Gueret P, Khalife K, Jobic Y, et al. Echocardiographic assessment of the incidence of mechanical complications during the early phase of myocardial infarction in the reperfusion era: a French multicentre prospective registry. Arch Cardiovasc Dis 2008; 101 (1): 41–7.

11. Kuznetsov VA, Yaroslavskaya EI, Pushkarev GS, et al. Chronic mitral regurgitation in post-myocardial infarction women with coronary artery disease: is the association with localization of coronary stenosis exists? Materials of All-Russian theoretical and practical conference “Cardiology in the light of new achievement of medical science” Moscow 2012; 40–1. Russian (Кузнецов В.А., Ярославская Е.И., Пушкарев Г.С. и др. Хроническая митральная регургитация у женщин с ИБС и постинфаркт- ным кардиосклерозом: есть ли связь с локализацией коронарных стенозов?) Материалы Всероссийской научно-практической конференции “Кардиология в свете новых достижений медицинской науки” Москва 2012; 40–1).

12. Akimova EV, Kuznetsov VA, Gafarov VV. Social gradient in Tyumen: cardiology point of view. Tyumen 2005. 200 p. Russian (Акимова Е.В., Кузнецов В.А., Гафаров В.В. Социальный градиент в Тюмени: точка зрения кардиолога. Тюмень 2005; 200 c).

13. Kuznetsov VA, Korjenkov AA. Heart false tendon. Diagnostic and clinical significance. Moscow, “Medical book” 2011. Russian (Кузнецов В.А., Корженков А.А. Ложные сухожилия сердца. Диагностика и клиническое значение. Москва “Медицинская книга” 2011; 271 c).

14. Dedov II, Melnichenko GA, Fadeev VV. Endocrinology. GEOTAR-Media 2007; 216 p. Russian (Дедов И.И., Мельниченко Г.А., Фадеев В.В. Эндокринология. ГЭОТАР- Медиа 2007; 216 c).

15. Kuznetsov VA, Yaroslavskaya EI, Zyrianov IP, et al. Comparison characteristic of patients with coronary artery disease without significant coronary stenosis in elderly end middle age. Heart 2010; 3 (9): 150–5. Russian (Кузнецов В.А., Ярославская Е.И., Зырянов И.П. и др. Сравнительная характеристика больных ИБС среднего и пожилого возраста при отсутствии гемодинамически значимых стенозов эпикардиальных коронарных артерий. Сердце 2010; 3 (9): 150–5).

16. Baycan S, Erdogan D, Caliskan M, et al. Coronary flow reserve is impaired in subclinical hypothyroidism. Clin Cardiol 2007; 30 (11): 562–6.