Sex-related differences in left ventricular remodeling in severe aortic stenosis and reverse remodeling after aortic valve replacement: A cardiovascular magnetic resonance study

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• 作者：Laura E. Dobson ; MBChB^a ; Timothy A. Fairbairn ; PhD^a ; Tarique A. Musa ; MBBS^a ; Akhlaque Uddin ; MBChB^a ; Cheryl A. Mundie ; PhD^b ; Peter P. Swoboda ; MBBS^a ; David P. Ripley ; MBChB^a ; Adam K. McDiarmid ; MBBS^a ; Bara Erhayiem ; BMBS^a ; Pankaj Garg ; MD^a ; Christopher J. Malkin ; MD^c ; Daniel J. Blackman ; MD^c ; Linda D. Sharples ; PhD^b ; Sven Plein ; PhD^a ; John P. Greenwood ; PhD^a ; ^{j.greenwood@leeds.ac.uk" class="auth_mail" title="E-mail the corresponding author}
• 关键词：AR ; Aortic regurgitation ; AS ; Aortic stenosis ; AVAi ; Indexed aortic valve area ; AVR ; Aortic valve replacement ; BSA ; Body surface area ; CABG ; Coronary artery bypass grafting ; CMR ; Cardiac magnetic resonance ; COPD ; Chronic obstructive pulmonary disease ; EuroSCORE ; European System for Cardiac Operative Risk Evaluation ; LA ; Left atrial ; LAVoli ; Indexed left atrial volume ; LGE ; Late gadolinium enhancement ; LV ; Left ventricular ; LVEDVi ; Indexed left ventricular end-diastolic volume ; LVEF ; Left ventric
• 刊名：American Heart Journal
• 出版年：2016
• 出版时间：May 2016
• 年：2016
• 卷：175
• 期：Complete
• 页码：101-111
• 全文大小：1037 K

文摘

Cardiac adaptation to aortic stenosis (AS) appears to differ according to sex, but reverse remodeling after aortic valve replacement has not been extensively described. The aim of the study was to determine using cardiac magnetic resonance imaging whether any sex-related differences exist in AS in terms of left ventricular (LV) remodeling, myocardial fibrosis, and reverse remodeling after valve replacement.

Methods

One hundred patients (men, n = 60) with severe AS undergoing either transcatheter or surgical aortic valve replacement underwent cardiac magnetic resonance scans at baseline and 6 months after valve replacement.

Results

Despite similar baseline comorbidity and severity of AS, women had a lower indexed LV mass than did men (65.3 ± 18.4 vs 81.5 ± 21.3 g/m², P < .001) and a smaller indexed LV end-diastolic volume (87.3 ± 17.5 vs 101.2 ± 28.6 mL/m², P = .002) with a similar LV ejection fraction (58.6% ± 10.2% vs 54.8% ± 12.9%, P = .178). Total myocardial fibrosis mass was similar between sexes (2.3 ± 4.1 vs 1.3 ± 1.1 g, P = .714), albeit with a differing distribution according to sex. After aortic valve replacement, men had more absolute LV mass regression than did women (18.3 ± 10.6 vs 12.7 ± 8.8 g/m², P = .007). When expressed as a percentage reduction of baseline indexed LV mass, mass regression was similar between the sexes (men 21.7% ± 10.1% vs women 18.4% ± 11.0%, P = .121). There was no sex-related difference in postprocedural LV ejection fraction or aortic regurgitation. Sex was not found to be a predictor of LV reverse remodeling on multiple regression analysis.

Conclusions

There are significant differences in the way that male and female hearts adapt to AS. Six months after aortic valve replacement, there are no sex-related differences in reverse remodeling, but superior reverse remodeling in men as a result of their more adverse remodeling profile at baseline.