title: Sex-related differences in left ventricular remodeling in severe aortic stenosis and reverse remodeling after aortic valve replacement: A cardiovascular magnetic resonance study.
abstract: Cardiac adaptation to aortic stenosis (AS) appears to differ according to sex, but reverse remodeling after aortic valve replacement has not been extensively described. The aim of the study was to determine using cardiac magnetic resonance imaging whether any sex-related differences exist in AS in terms of left ventricular (LV) remodeling, myocardial fibrosis, and reverse remodeling after valve replacement.
  
  
  
  One hundred patients (men, n = 60) with severe AS undergoing either transcatheter or surgical aortic valve replacement underwent cardiac magnetic resonance scans at baseline and 6 months after valve replacement.
  
  
  
  Despite similar baseline comorbidity and severity of AS, women had a lower indexed LV mass than did men (65.3 ± 18.4 vs 81.5 ± 21.3 g/m(2), P < .001) and a smaller indexed LV end-diastolic volume (87.3 ± 17.5 vs 101.2 ± 28.6 mL/m(2), P = .002) with a similar LV ejection fraction (58.6% ± 10.2% vs 54.8% ± 12.9%, P = .178). Total myocardial fibrosis mass was similar between sexes (2.3 ± 4.1 vs 1.3 ± 1.1 g, P = .714), albeit with a differing distribution according to sex. After aortic valve replacement, men had more absolute LV mass regression than did women (18.3 ± 10.6 vs 12.7 ± 8.8 g/m(2), P = .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 = .121). There was no sex-related difference in postprocedural LV ejection fraction or aortic regurgitation. Sex was not found to be a predictor of LV reverse remodeling on multiple regression analysis.
  
  
  
  There are significant differences in the way that male and female hearts adapt to AS. Six months after 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.
authors.affiliation: Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, United Kingdom.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Dobson
authors.affiliation: Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, United Kingdom.
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Fairbairn
authors.affiliation: Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, United Kingdom.
authors.forename: Tarique A
authors.initials: TA
authors.lastname: Musa
authors.affiliation: Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, United Kingdom.
authors.forename: Akhlaque
authors.initials: A
authors.lastname: Uddin
authors.affiliation: Clinical Trials Research Unit (CTRU), University of Leeds, Leeds, United Kingdom.
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Mundie
authors.affiliation: Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, United Kingdom.
authors.forename: Peter P
authors.initials: PP
authors.lastname: Swoboda
authors.affiliation: Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, United Kingdom.
authors.forename: David P
authors.initials: DP
authors.lastname: Ripley
authors.affiliation: Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, United Kingdom.
authors.forename: Adam K
authors.initials: AK
authors.lastname: McDiarmid
authors.affiliation: Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, United Kingdom.
authors.forename: Bara
authors.initials: B
authors.lastname: Erhayiem
authors.affiliation: Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, United Kingdom.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Garg
authors.affiliation: Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Malkin
authors.affiliation: Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Blackman
authors.affiliation: Clinical Trials Research Unit (CTRU), University of Leeds, Leeds, United Kingdom.
authors.forename: Linda D
authors.initials: LD
authors.lastname: Sharples
authors.affiliation: Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, United Kingdom.
authors.forename: Sven
authors.initials: S
authors.lastname: Plein
authors.affiliation: Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, United Kingdom. Electronic address: j.greenwood@leeds.ac.uk.
authors.forename: John P
authors.initials: JP
authors.lastname: Greenwood
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006352:Heart Ventricles / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009929:Organ Size; D011184:Postoperative Period; D012737:Sex Factors; D013223:Statistics as Topic; D013318:Stroke Volume; D006113:United Kingdom; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling