Sex differences in left ventricular remodelling in patients with severe aortic valve stenosis

Abstract

Aims Women with severe aortic stenosis (AS) have better long-term outcome after transcatheter aortic valve implantation (TAVI) but worse survival after surgical aortic valve replacement compared with men. Whether this is related to sex differences in left ventricular (LV) remodelling is unknown. The aim of this study was to examine the sex differences in LV remodelling with multidetector row computed tomography (MDCT) and outcome in patients with severe AS undergoing TAVI between 2007 and 2018. Methods and results A total of 289 patients (age 80 ± 6 years, 54% male) were included. LV volumes, mass, and function were analysed on pre-procedural MDCT scans. Women showed smaller LV volumes and mass compared with men. Patients were classified into four LV remodelling patterns: concentric hypertrophy (50%) was the most frequent pattern of LV remodelling followed by eccentric hypertrophy (33%), normal geometry (13%), and concentric remodelling (4%). Men showed more concentric remodelling compared with women (91% vs. 9%, respectively, P = 0.011). However, no differences were observed in the remaining LV remodelling patterns. During a median follow-up of 3.8 (IQR 2.2–5.1) years after TAVI, 87 (30%) patients died. Women demonstrated better outcome after TAVI compared with men (log-rank χ2 = 4.29, P = 0.038). No association was observed between the interaction of the LV remodelling patterns and sex with outcome. Conclusion LV concentric hypertrophy and eccentric hypertrophy are similarly observed in men and women with severe AS but concentric remodelling was more common in men. Women demonstrated better outcome after TAVI when compared with men. The interaction between the LV remodelling patterns and sex was not associated with survival.

Multimodality Imaging to Explore Sex Differences in Aortic Stenosis

“…[ 51 ] In contrast to echocardiographic studies, Kuneman et al reported more LV concentric remodelling in men with severe AS compared with women, whereas the frequency of the other LV remodelling patterns was similar in both sexes. [ 10 ] Furthermore, there was a significant association between LV concentric hypertrophy and poor survival in men, findings that contrast with the echocardiographic study. [ 46 ] Differences in the type of patients and imaging techniques used to assess LV remodelling may explain the discrepant results of the studies.…”

“…Contrast-enhanced CT can also be used for characterisation of LV remodelling in response to severe AS. [ 10 ] This 3D imaging technique provides high spatial resolution images to assess LV mass and volumes. Furthermore, novel technologies allow the assessment of the extracellular volume as a measure of myocardial fibrosis.…”

“…7 As well as sex differences in the valvular lesion, sex differences in left ventricular (LV) remodelling and myocardial fibrosis in response to AS, have also been reported. [8][9][10] Men demonstrate more LV systolic dysfunction, impaired LV global longitudinal strain, larger LV mass and volumes and more myocardial fibrosis compared with women. In addition, men show more concentric and eccentric LV hypertrophy, whereas women show more concentric LV remodelling.…”

Interaction Between Sex and Left Ventricular Reverse Remodeling and Its Association with Outcomes After Transcatheter Aortic Valve Implantation

“…Another explanation may be the sex-speci c myocardial remodeling in AS. Previously, our group examined the impact of sex on LV remodeling before TAVI and reported that the outcome bene ts of women after TAVI were not associated with sex differences in LV remodeling [33]. However, the impact of the potential sex-related differences in LV reverse remodeling after TAVI on outcomes remained unexplored.…”

“…Changes in LV volumes and LV mass index as well as LVEF over time, are displayed in Figure1. At 6 and 12 months after TAVI, both men and women showed a signi cant reduction in LVEDVi (from 48 [39-59] ml/m 2 to 44 [37-55] ml/m 2 at 6 months and to 43[34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53] ml/m 2 at 12 months after TAVI; and from 39[33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50] ml/m 2 to 38[31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] ml/m 2 at 6 months and to 36 [28-43] ml/m 2 at 12 months, respectively, both p<0.001) and in LVESVi (men: from 22[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] ml/m 2 to 20 [16-27] ml/m 2 at 6 months and to 19[15- …”