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Abbreviations: HTN, hypertension; DM, diabetes mellitus; (Chol, hypercholesterolemia; MI, myocardial infarction; CHF, congestive heart failure; USAP, unstable angina pectoris. bp < 0.001. cp < 0.05.

Abbreviations: HTN, hypertension; DM, diabetes mellitus; (Chol, hypercholesterolemia; MI, myocardial infarction; CHF, congestive heart failure; USAP, unstable angina pectoris. bp < 0.001. cp < 0.05.

Fig. 8. Congestive heart failure in women with coronary artery disease. Although there is an increased prevalence of congestive heart failure in women compared to men, women have a higher left ventricular ejection fraction and a lower left ventricular end-diastolic volume suggesting that diastolic dysfunction contributes significantly to congestive heart failure symptoms in women. LVEF, left ventricular ejection fraction; LVEDV, left ventricular end-diastolic volume; LVEDP, left-ventricular end-dias-tolic pressure (95).

LVEF LVEDV LVEDP

Fig. 8. Congestive heart failure in women with coronary artery disease. Although there is an increased prevalence of congestive heart failure in women compared to men, women have a higher left ventricular ejection fraction and a lower left ventricular end-diastolic volume suggesting that diastolic dysfunction contributes significantly to congestive heart failure symptoms in women. LVEF, left ventricular ejection fraction; LVEDV, left ventricular end-diastolic volume; LVEDP, left-ventricular end-dias-tolic pressure (95).

this "gender paradox" has been explained by the presence of diastolic dysfunction and the finding of a steep left ventricular pressure-volume relationship in women in comparison to men (Fig. 8) (95). Whether ischemia in women is due to diastolic dysfunction is unclear, but the latter may partially explain the increased occurrence of unstable symptoms despite a lower incidence of multivessel coronary disease in women compared to men.

Despite gender-related differences in referral patterns for the use of diagnostic cardiac catheterization, at catheterization, women have been shown to have the same or less angiographic evidence for coronary artery disease than men despite reporting more functional disability in terms of anginal chest pain. In fact, women undergoing coronary revascularization are more likely to have severe angina (Canadian class III or IV) and unstable symptoms than men (96,97). One explanation for this finding is a gender-related difference in the pathophysiology of the ruptured plaque (98,99).

Women who are found to have significant epicardial coronary stenoses at cardiac catheterization present with the same degree of coronary artery disease in comparison to men with respect to severity and distribution of lesions (100,101), including the prevalence of left main and three-vessel disease (73). In fact, over a 16-yr period, there was no significant gender difference observed with respect to extent and localization of coronary lesions in patients with angiographically documented coronary artery disease. Of note, there was a significant shift from the diagnosis of multivessel disease toward single-vessel disease in both men and women indicating that, over time, diagnostic car-

Table 3

Gender Differences in Operative Mortality in Patients Undergoing Coronary Artery Bypass Surgery3

Table 3

Gender Differences in Operative Mortality in Patients Undergoing Coronary Artery Bypass Surgery3

Authors

Patients

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