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Sex Dimorphism in the Myocardial Response to Aortic Stenosis.
JACC: Cardiovascular Imaging ( IF 12.8 ) Pub Date : 2017-11-15 , DOI: 10.1016/j.jcmg.2017.08.025 Thomas A Treibel 1 , Rebecca Kozor 2 , Marianna Fontana 3 , Camilla Torlasco 4 , Patricia Reant 5 , Sveeta Badiani 4 , Maria Espinoza 4 , John Yap 4 , Javier Diez 6 , Alun D Hughes 3 , Guy Lloyd 1 , James C Moon 1
JACC: Cardiovascular Imaging ( IF 12.8 ) Pub Date : 2017-11-15 , DOI: 10.1016/j.jcmg.2017.08.025 Thomas A Treibel 1 , Rebecca Kozor 2 , Marianna Fontana 3 , Camilla Torlasco 4 , Patricia Reant 5 , Sveeta Badiani 4 , Maria Espinoza 4 , John Yap 4 , Javier Diez 6 , Alun D Hughes 3 , Guy Lloyd 1 , James C Moon 1
Affiliation
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OBJECTIVES
The goal of this study was to explore sex differences in myocardial remodeling in aortic stenosis (AS) by using echocardiography, cardiac magnetic resonance (CMR), and biomarkers.
BACKGROUND
AS is a disease of both valve and left ventricle (LV). Sex differences in LV remodeling are reported in AS and may play a role in disease phenotyping.
METHODS
This study was a prospective assessment of patients awaiting surgical valve replacement for severe AS using echocardiography, the 6-min walking test, biomarkers (high-sensitivity troponin T and N-terminal pro-brain natriuretic peptide), and CMR with late gadolinium enhancement and extracellular volume fraction, which dichotomizes the myocardium into matrix and cell volumes. LV remodeling was categorized into normal geometry, concentric remodeling, concentric hypertrophy, and eccentric hypertrophy.
RESULTS
In 168 patients (age 70 ± 10 years, 55% male, indexed aortic valve area 0.40 ± 0.13 cm2/m2, mean gradient 47 ± 4 mm Hg), no sex or age differences in AS severity or functional capacity (6-min walking test) were found. CMR captured sex dimorphism in LV remodeling not apparent by using 2-dimensional echocardiography. Normal geometry (82% female) and concentric remodeling (60% female) dominated in women; concentric hypertrophy (71% male) and eccentric hypertrophy (76% male) dominated in men. Men also had more evidence of LV decompensation (pleural effusions), lower left ventricular ejection fraction (67 ± 16% vs. 74 ± 13%; p < 0.001), and higher levels of N-terminal pro-brain natriuretic peptide (p = 0.04) and high-sensitivity troponin T (p = 0.01). Myocardial fibrosis was higher in men, with higher focal fibrosis (late gadolinium enhancement 16.5 ± 11.2 g vs. 10.5 ± 8.9 g; p < 0.001) and extracellular expansion (matrix volume 28.5 ± 8.8 ml/m2 vs. 21.4 ± 6.3 ml/m2; p < 0.001).
CONCLUSIONS
CMR revealed sex differences in associations between AS and myocardial remodeling not evident from echocardiography. Given equal valve severity, the myocardial response to AS seems more maladaptive in men than previously reported. (Regression of Myocardial Fibrosis After Aortic Valve Replacement [RELIEF-AS]; NCT02174471).
中文翻译：
心肌对主动脉瓣狭窄反应的性别二态性。
目的 本研究的目的是通过超声心动图、心脏磁共振 (CMR) 和生物标志物探讨主动脉瓣狭窄 (AS) 心肌重塑的性别差异。背景AS是瓣膜和左心室(LV)的疾病。据报道，AS 中左室重塑存在性别差异，并且可能在疾病表型分析中发挥作用。方法 本研究使用超声心动图、6 分钟步行试验、生物标志物（高敏肌钙蛋白 T 和 N 末端脑利钠肽前体）和晚期钆增强 CMR 对等待手术瓣膜置换术的严重 AS 患者进行前瞻性评估和细胞外体积分数，将心肌分为基质和细胞体积。左心室重构分为正常几何结构、向心重构、向心肥大和偏心肥大。结果 在 168 名患者中（年龄 70 ± 10 岁，55% 男性，指数主动脉瓣面积 0.40 ± 0.13 cm2/m2，平均梯度 47 ± 4 mm Hg），AS 严重程度或功能能力（6 分钟）没有性别或年龄差异步行测试）被发现。 CMR 捕获了 LV 重塑中的性别二态性，而使用二维超声心动图则不明显。正常几何形状（82% 女性）和同心重塑（60% 女性）在女性中占主导地位；男性以向心性肥大（71%男性）和离心性肥大（76%男性）为主。男性也有更多左心室失代偿（胸腔积液）、左心室射血分数降低（67 ± 16% vs. 74 ± 13%；p < 0.001）以及 N 端脑钠肽前体水平较高（p = 0.04) 和高敏肌钙蛋白 T (p = 0.01)。男性心肌纤维化程度更高，局灶性纤维化程度更高（晚期钆增强 16.5 ± 11.2 g vs. 10.5 ± 8.9 g；p < 0。001）和细胞外扩张（基质体积 28.5 ± 8.8 ml/m2 对比 21.4 ± 6.3 ml/m2；p < 0.001）。结论 CMR 揭示了 AS 与心肌重塑之间关联的性别差异，而超声心动图则不明显。考虑到相同的瓣膜严重程度，男性对 AS 的心肌反应似乎比之前报道的更适应不良。 （主动脉瓣置换术后心肌纤维化的消退 [RELIEF-AS]；NCT02174471）。
更新日期：2018-07-02
中文翻译：
心肌对主动脉瓣狭窄反应的性别二态性。
目的 本研究的目的是通过超声心动图、心脏磁共振 (CMR) 和生物标志物探讨主动脉瓣狭窄 (AS) 心肌重塑的性别差异。背景AS是瓣膜和左心室(LV)的疾病。据报道，AS 中左室重塑存在性别差异，并且可能在疾病表型分析中发挥作用。方法 本研究使用超声心动图、6 分钟步行试验、生物标志物（高敏肌钙蛋白 T 和 N 末端脑利钠肽前体）和晚期钆增强 CMR 对等待手术瓣膜置换术的严重 AS 患者进行前瞻性评估和细胞外体积分数，将心肌分为基质和细胞体积。左心室重构分为正常几何结构、向心重构、向心肥大和偏心肥大。结果 在 168 名患者中（年龄 70 ± 10 岁，55% 男性，指数主动脉瓣面积 0.40 ± 0.13 cm2/m2，平均梯度 47 ± 4 mm Hg），AS 严重程度或功能能力（6 分钟）没有性别或年龄差异步行测试）被发现。 CMR 捕获了 LV 重塑中的性别二态性，而使用二维超声心动图则不明显。正常几何形状（82% 女性）和同心重塑（60% 女性）在女性中占主导地位；男性以向心性肥大（71%男性）和离心性肥大（76%男性）为主。男性也有更多左心室失代偿（胸腔积液）、左心室射血分数降低（67 ± 16% vs. 74 ± 13%；p < 0.001）以及 N 端脑钠肽前体水平较高（p = 0.04) 和高敏肌钙蛋白 T (p = 0.01)。男性心肌纤维化程度更高，局灶性纤维化程度更高（晚期钆增强 16.5 ± 11.2 g vs. 10.5 ± 8.9 g；p < 0。001）和细胞外扩张（基质体积 28.5 ± 8.8 ml/m2 对比 21.4 ± 6.3 ml/m2；p < 0.001）。结论 CMR 揭示了 AS 与心肌重塑之间关联的性别差异，而超声心动图则不明显。考虑到相同的瓣膜严重程度，男性对 AS 的心肌反应似乎比之前报道的更适应不良。 （主动脉瓣置换术后心肌纤维化的消退 [RELIEF-AS]；NCT02174471）。
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