Sex differences in left ventricular remodelling, myocardial fibrosis and mortality after aortic valve replacement
journal contributionposted on 2020-05-14, 10:54 authored by Anvesha Singh, Tarique Al Musa, Thomas A Treibel, Vassiliou S Vassiliou, Gabriella Captur, Calvin Chin, Laura E Dobson, Silvia Pica, Margaret Loudon, Tamir Malley, Marzia Rigolli, James Robert John Foley, Petra Bijsterveld, Graham R Law, Marc Richard Dweck, Saul G Myerson, Sanjay K Prasad, James C Moon, John P Greenwood, Gerry P McCann
Objectives To investigate sex differences in left ventricular remodelling and outcome in patients undergoing surgical or transcatheter aortic valve replacement (SAVR/TAVR). Methods In this multicentre, observational, outcome study with imaging core-lab analysis, patients with severe aortic stenosis (AS) listed for intervention at one of six UK centres were prospectively recruited and underwent cardiovascular magnetic resonance imaging. The primary endpoint was all-cause mortality and secondary endpoint was cardiovascular mortality. Results 674 patients (425 men, 249 women, age 75±14 years) were included: 399 SAVR, 275 TAVR. Women were older, had higher surgical risk scores and underwent TAVR more frequently (53% vs 33.6%, p<0.001). More men had bicuspid aortic valves (BAVs) (26.7% vs 14.9%, p<0.001) and demonstrated more advanced remodelling than women. During a median follow-up of 3.6 years, 145 (21.5%) patients died, with no significant sex difference in all-cause mortality (23.3% vs 20.5%, p=0.114), but higher cardiovascular mortality in women (13.7% vs 8.5%, p=0.012). There were no significant sex-related differences in outcome in the SAVR or TAVR subgroups, or after excluding those with BAV. Factors independently associated with all-cause mortality were age, left ventricular ejection fraction (LVEF), BAV (better) and myocardial fibrosis detected with late gadolinium enhancement (LGE) in men, and age, LVEF and LGE in women. Age and LGE were independently associated with cardiovascular mortality in both sexes. Conclusions Men demonstrate more advanced remodelling in response to a similar severity of AS. The higher cardiovascular mortality observed in women following AVR is accounted for by women having less BAV and higher risk scores resulting in more TAVR. LGE is associated with a worse prognosis in both sexes.
This study was in part supported by the British heart Foundation (University of leeds, greenwood JP [Pg/11/126/29321]; University of leicester, Mccann gP [Pg/07/068/2334]; University of Oxford, Myerson sg [Fs/10/015/28104]; University of edinburgh, Dweck Mr [Fs/10/026]; University college london, Moon Jc [Fs/08/028/24767]), the national institute for health research (University of leicester, Mccann PDF 2011-04-51; University college london, treibel ta [DrF-2013-06-102]), including via its Biomedical research centre and clinical research Facility programmes, as well as rosetrees trust.
CitationHeart 2019; 105:1818-1824
Author affiliationCollege of Life Sciences
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