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15 November 1994 | Volume 121 Issue 10 | Pages 815-816
Mensah and colleagues raise several interesting points about the mechanisms responsible for the higher morbidity and mortality rates in women after acute myocardial infarction. The Thrombolysis in Myocardial Infarction (TIMI II) database was explored to evaluate potential sex-related differences in left ventricular hypertrophy (Table 1). REPLY
Sex-related Outcome Differences after Acute Myocardial Infarction
IN RESPONSE:
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Although we could not uncover any sex-related differences, several limitations do exist. First, TIMI II used strict entry criteria and excluded patients with uncontrolled hypertension [1]. Second, simplified R-wave criteria (Lyons criteria) were the only means available to assess the occurrence of left ventricular hypertrophy. Previous studies have shown that electrocardiographic criteria, although specific, lack sensitivity, particularly among women [2]. Other assessments of left ventricular hypertrophy such as echocardiography were not routinely done in TIMI II [3-5].
We appreciate the interest of Dr. Mensah and colleagues in our work and agree that left ventricular hypertrophy among women and men experiencing acute myocardial infarction is of concern and must be addressed in future studies.
References
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 Top References |
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1. Becker RC, Terrin M, Ross R, Knatterud GL, Desvigne-Nickens P, Gore JM, et al. Comparison of clinical outcomes for women and men after acute myocardial infarction. Ann Intern Med. 1994; 120:638-45.
2. Levy D, Labib SB, Anderson KM, Christiansen JC, Kannel WB, Castelli WP. Determinants of sensitivity and specificity of electrocardiographic criteria for left ventricular hypertrophy. Circulation. 1990; 81:815-20.
3. Devereux RB, Reichek N. Echocardiographic determination of left ventricular mass in man: anatomic validation of the method. Circulation. 1977; 55:613-8.
4. Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol. 1986; 57:450-8.
5. Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP. Left ventricular mass and incidence of coronary heart disease in an elderly cohort. Ann Intern Med. 1989; 110:101-7.
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