Sex-Related Differences in the Extent of Myocardial Fibrosis in Patients With Aortic Valve Stenosis

JACC Cardiovasc Imaging. 2020 Mar;13(3):699-711. doi: 10.1016/j.jcmg.2019.06.014. Epub 2019 Aug 14.

Abstract

Objectives: The aim of this study was to assess the effect of sex on myocardial fibrosis as assessed by using cardiac magnetic resonance (CMR) imaging in aortic stenosis (AS).

Background: Previous studies reported sex-related differences in the left ventricular (LV) remodeling response to pressure overload in AS. However, there are very few data regarding the effect of sex on myocardial fibrosis, a key marker of LV decompensation and adverse cardiac events in AS.

Methods: A total of 249 patients (mean age 66 ± 13 years; 30% women) with at least mild AS were recruited from 2 prospective observational cohort studies and underwent comprehensive Doppler echocardiography and CMR examinations. On CMR, T1 mapping was used to quantify extracellular volume (ECV) fraction as a marker of diffuse fibrosis, and late gadolinium enhancement (LGE) was used to assess focal fibrosis.

Results: There was no difference in age between women and men (age 66 ± 15 years vs 66 ± 12 years; p = 0.78). However, women presented with a better cardiovascular risk profile than men with less hypertension, dyslipidemia, diabetes, and coronary artery disease (all, p ≤ 0.10). As expected, LV mass index measured by CMR imaging was smaller in women than in men (p < 0.0001). Despite fewer comorbidities, women presented with larger ECV fraction (median: 29.0% [25th to 75th percentiles: 27.4% to 30.6%] vs. 26.8% [25th to 75th percentiles: 25.1% to 28.7%]; p < 0.0001) and similar LGE (median: 4.5% [25th-75th percentiles: 2.3% to 7.0%] vs. 2.8% [25th-75th percentiles: 0.6% to 6.8%]; p = 0.20) than men. In multivariable analysis, female sex remained an independent determinant of higher ECV fraction and LGE (all, p ≤ 0.05).

Conclusions: Women have greater diffuse and focal myocardial fibrosis independent of the degree of AS severity. These findings further emphasize the sex-related differences in LV remodeling response to pressure overload.

Keywords: aortic stenosis; myocardial fibrosis; sex differences.

Publication types

  • Comparative Study
  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Valve Stenosis / diagnostic imaging*
  • Aortic Valve Stenosis / pathology
  • Aortic Valve Stenosis / physiopathology
  • Cross-Sectional Studies
  • Female
  • Fibrosis
  • Health Status Disparities*
  • Humans
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Myocardium / pathology*
  • Predictive Value of Tests
  • Prospective Studies
  • Quebec
  • Risk Factors
  • Scotland
  • Severity of Illness Index
  • Sex Factors
  • Ventricular Function, Left
  • Ventricular Remodeling