Sex-related differences in left ventricular remodeling in severe aortic stenosis and reverse remodeling following aortic valve replacement; a cardiovascular magnetic resonance study

• Published in: The American heart journal
• Main Authors: Dobson, L.E., MBChB, Fairbairn, T.A., PhD, Musa, T.A., MBBS, Uddin, A., MBChB, Mundie, C.A., PhD, Swoboda, P.P., MBBS, Ripley, D.P., MBChB, McDiarmid, A.K., MBBS, Erhayiem, B., BMBS, Garg, P., MD, Malkin, C.J., MD, Blackman, D.J., MD, Sharples, L.D., PhD, Plein, S., PhD, Greenwood, J.P., PhD
• Format: Journal Article
• Language: English
• Published: 2015
• Subjects: Cardiovascular
• ISSN: 0002-8703
• DOI: 10.1016/j.ahj.2016.02.010

Abstract Background Cardiac adaptation to aortic stenosis (AS) appears to differ according to sex but reverse remodeling following aortic valve replacement has not been extensively described. The aim of the study was to determine using cardiac magnetic resonance (CMR) 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 trans-catheter or surgical aortic valve replacement underwent CMR scans at baseline and 6m following valve replacement. Results Despite similar baseline co-morbidity and severity of AS, women had a lower indexed LV mass than men (65.3± 18.4 vs. 81.5±21.3g/m2 , p<0.001) and a smaller indexed LV end diastolic volume (87.3±17.5 vs. 101.2±28.6ml/m2 , p=0.002) with a similar LV ejection fraction (LVEF) (58.6±10.2 vs. 54.8±12.9%, p=0.178). Total myocardial fibrosis mass was similar between sexes (2.3±4.1 vs. 1.3±1.1g, p=0.714) albeit with a differing distribution according to sex. Following aortic valve replacement, men had more absolute LV mass regression than females (18.3±10.6 vs. 12.7±8.8g/m2 , p=0.007). 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=0.121). There was no sex-related difference in post-procedural LVEF or aortic regurgitation. Sex was not found to a predictor of LV reverse remodelling on multiple regression analysis. Conclusions There are significant differences in the way that male and female hearts adapt to AS. 6m following 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.