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

Abstract

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Mass Regression after Aortic Valve Replacement in Aortic Stenosis: A Comparison between "Appropriate" and "Inappropriate" Left Ventricular Hypertrophy

“…In our study, gender and diabetes were unevenly distributed between the groups, while for the BMI there was a trend in being higher in the group with "inappropriate" hypertrophy ( Table 1). The gender issue was in line with other studies in which was demonstrated that male gender easily develops a higher LVM, fibrosis deposition and LV dysfunction than females [34][35][36].…”

Calcific Aortic Valve Disease

“…In the context of CAVD, there is scant information on sex-specific differences in valve biology or pathology. While several studies have demonstrated higher prevalence of CAVD amongst males, investigations that explicitly focus on this issue have concentrated on sex differences in ventricular or vascular dysfunction caused by CAVD [4, 5], rather than the valve itself. Moreover, the majority of in vitro valve investigations use valvular interstitial cell (VIC) cultures that are not separated by sex, or whose sex is unknown.…”

Aortic stenosis in women

“…However, in a recent study, women and men had similar LV mass (LVM) and prevalence of LV hypertrophy for similar AS severity, regardless whether LVM was indexed for BSA or height 1.7 16. However, with cardiac MRI (CMRI), women often exhibited lower LVM with a smaller LV cavity size, whereas men developed a larger LV cavity and greater LV wall thickness and mass for similar AS severity and comorbidities 17 18. Treibel et al observed that women with AS presented more often with normal geometry and concentric remodelling pattern of the LV, while men developed concentric hypertrophy or eccentric hypertrophy 19.…”

“…Two patterns of fibrosis are typical: focal fibrosis is irreversible, occurs late in the natural history of a disease and can be identified by late gadolinium enhancement (LGE), while diffuse fibrosis occurs earlier, is reversible and can be quantified by extracellular volume (ECV) fraction by T 1 mapping 21. Compared with women, equal or higher LGE and ECV have been observed in men with severe AS 17 19. In contrast, another study of 249 patients with less severe AS (mild to moderate AS in 70%), women presented with greater ECV fraction and similar LGE across the whole range of AS severity 18.…”