Myocardial Fibrosis in Severe Aortic Stenosis: A Matter of Sex?

Courtesy of Dr. Carlos Fava.

Aortic valve calcification and its resulting stenosis leads to changes in left ventricle hemodynamics, producing diffuse ischemia followed by inflammation, increased extracellular matrix, necrosis, and later, diffuse fibrosis. 

At present, with magnetic resonance imaging (MRI) we can analyze ventricular architecture and its function by detecting fibrosis (LGE) and its volume (ECV).

Even though we know there are certain differences depending on age, disease development and sex, these have been poorly stratified and still remain unclear. 

The study included 175 patients. 132 were men (75%) who presented at least mild aortic stenosis by eco-Doppler and CMR. LGE and ECV were analyzed.

There were no differences between men and women. Mean age was 66, body mass index was 28 kg/m2, there were no differences in blood pressure or functional class, but women presented less diabetes, dyslipidemia, and CAD.

Read also: In Search of the Optimal Depth for Self-Expandable Valves.

The outcomes showed women presented larger ECV fraction (median: 29.0% [25th–75th percentiles: 27.4% to 30.6%] vs. 26.8% [25th–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) compared against men. Multivariable analysis showed female sex was an independent factor of higher ECV and LGE (p=0.05). 

Conclusion

Women have higher diffuse and focal myocardial fibrosis regardless aortic stenosis severity. These findings emphasize even more the differences between men and women as to left ventricular remodeling in response to pressure overload. 

Courtesy of Dr. Carlos Fava.

Original Tite: Sex-Related Differences in the Extent of Myocardial Fibrosis in Patients With Aortic Valve Stenosis.

Reference: Lionel Tastet, et al. J Am Coll Cardiol Img 2020;13:699-711.

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