Anne Dunkel

Regression of Myocardial Hypertrophy After Aortic Valve Replacement Faster in Women

Background— In patients with aortic stenosis, pressure overload induces cardiac hypertrophy and fibrosis. Female sex and estrogens influence cardiac remodeling and fibrosis in animal models and in men. Sex differences and their molecular mechanisms in hypertrophy regression after aortic valve replacement have not yet been studied. Methods and Results— We prospectively obtained preoperative and early postoperative echocardiography in 92 patients, 53 women and 39 men, undergoing aortic valve replacement for isolated aortic stenosis. We analyzed in a subgroup of 10 patients matrix gene expression in left ventricular (LV) biopsies. In addition, we determined the effect of 17&bgr;-estradiol on collagen synthesis in isolated rat cardiac fibroblasts. Preoperatively, women and men had similar ejection fraction. Similar percentages of women and men had increased LV diameters (37% and 38%). Women more frequently exhibited LV hypertrophy than men (women: 86%; men: 56%; P<0.01). Postoperatively, increased LV diameters persisted in 34% of men but only in 12% of women (P<0.023). LV hypertrophy reversed more frequently in women than in men, leading to a similar prevalence of LV hypertrophy after surgery (women: 45%; men: 36%). In surgical biopsies, men had significantly higher collagen I and III and matrix metalloproteinase 2 gene expression than women. In isolated rat cardiac fibroblasts, 17&bgr;-estradiol significantly increased collagen I and III gene expressions in male cells but decreased it in female cells. Conclusion— Women adapt to pressure overload differently from men. Less fibrosis before surgery may enable faster regression after surgery.

Screening for depression: Rasch analysis of the dimensional structure of the PHQ-9 and the HADS-D

BACKGROUND Both the depression modules of the Hospital Anxiety and Depression Scale (HADS-D) and the Patient Health Questionnaire (PHQ-9) are widely used for the screening of depression. We analyzed the dimensionality and the item fit of both scales individually and across the scales. Moreover, we sought to identify items which evidenced item response bias associated with age and gender. METHODS The depression subscales HADS-D and the PHQ-9 were administered to 1271 patients (mean age 67.2; 22.5% women) undergoing coronary artery bypass graft surgery (CABG). Rasch analyses were performed to assess the overall fit of the model, individual item fit and differential item functioning (DIF). RESULTS Rasch analysis revealed that the HADS-D and the PHQ-9 feature a common core construct containing six items of the HADS-D and three items of the PHQ-9. Two of these items are identical with the 2-item short form of the PHQ-9. In addition, fatigability was the only somatic item that fitted the model. No substantial DIF was observed. LIMITATIONS The generalizability of these results might be restricted to patients awaiting CABG. CONCLUSIONS The short form of the PHQ-9 seems to be an economic and valid instrument for the screening of depression, which indicates the same latent construct that is captured by six items of the HADS-D. Further studies are needed to evaluate whether the addition of fatigability might enhance the validity of the PHQ-2 in this patient population.

Gender Differences in Health-related Quality of Life After Coronary Bypass Surgery: Results From a 1-year Follow-up in Propensity-matched Men and Women

Objective: To examine whether the predictive value of gender for health-related quality of life (HRQoL) is independent of clinical health status and depression. Women undergoing coronary bypass surgery generally report a poorer HRQoL than men. Methods: A total of 990 (20% women) patients completed study questionnaires 1 day before coronary bypass surgery and 1 year after surgery. Physical aspects of HRQoL were assessed with the Short Form 36 Health Survey. Depression was measured with the self-reported Patient Health Questionnaire. Propensity score matching was applied to match men and women with respect to 65 clinical variables. Of 198 women, 157 (79.3%) could be matched to a partner, resulting in an excellent balance of clinical variables between the matched groups. Results: At baseline, propensity-matched men and women differed in physical functioning (p < .001) and role functioning (p = .007), but not in bodily pain and general health perception. In both men and women, HRQoL outcomes improved over 1 year. Preoperative depression predicted worse physical HRQoL in all outcomes, except general health perception 1 year after surgery. After adjusting for depression, gender lost its predictive power with respect to physical functioning. However, compared with women, men still reported a better role functioning. Conclusion: Our data suggest that gender is a marker for role functioning, independent of the clinical health status and depression. Rehabilitation measures designed for the specific needs of women might help to improve their HRQoL. CABG = coronary artery bypass graft; PF = physical functioning; RP = role functioning; BP = bodily pain; GH = general health; SF-36 = Medical Outcomes Study 36-Item Short Form Health Survey.

Geschlechterunterschiede in der Lebensqualität vor aortokoronarer Bypass-Operation

Objectives: Women before aortocoronary bypass surgery have a worse health related quality of life (HRQoL) than men. Yet it is not clear how this gender difference relates to a less favourable risk factor p rofile of women compared to men. Methods: The sample consisted of 1587 patients (23% women), who fille d out a questionnaire on HRQoL, the SF-36, 1 ‐ 3 days before coronary bypass surgery. Two hundred ninety-nine women and 299 men with a similar clinical risk factor profile were matched on the propensity s core and were compared with respect to their HRQoL. Results: The preoperative marked gender differences in HRQoL were reduced in all subscales of the SF-36. However, except for general health perception and physical pain, they remained significant. An inspection of effect sizes showed the greatest decrease in gender differences in physical functioning (d = 0.64 versus d = 0.42), followed by physical role function (d = 0.46 versus d = 0.25), physical pain (d = 0.20 versus d = 0.07), and general health perception (d = 0.20 versus d = 0.07). In the mental subscales, except for vitality (d = 0.52 versus d = 0.33), matching led to only marginal changes. Conclusion: Particularly in the physical subscales of the SF-36 matching led to a decrease in gender differences. In coronary bypass patients, female gender seems to constitute an independent predictor of worse HRQoL.