Author + information
- Received February 13, 2019
- Revision received June 13, 2019
- Accepted June 14, 2019
- Published online March 2, 2020.
- Lionel Tastet, MSca,∗,
- Jacek Kwiecinski, MDb,∗,
- Philippe Pibarot, DVM, PhDa,
- Romain Capoulade, PhDa,
- Russell J. Everett, MDb,
- David E. Newby, MD, PhDb,
- Mylène Shen, MSca,
- Ezequiel Guzzetti, MDa,
- Marie Arsenault, MDa,
- Élisabeth Bédard, MDa,
- Éric Larose, MD, MSca,
- Jonathan Beaudoin, MDa,
- Marc Dweck, MD, PhDb,† and
- Marie-Annick Clavel, DVM, PhDa,†∗ ()
- aInstitut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Laval University, Québec City, Québec, Canada
- bBritish Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
- ↵∗Address for correspondence:
Dr. Marie-Annick Clavel, Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Sainte-Foy, Québec City, Québec G1V 4G5, Canada.
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.
↵∗ Mr. Tastet and Dr. Kwiecinski have contributed equally and should be considered first author.
↵† Drs. Dweck and Clavel are joint senior authors.
This work was supported by grants (FDN-143225 and MOP-114997) from the Canadian Institutes of Health Research (CIHR), a grant from the Foundation of the Québec Heart and Lung Institute, and a grant (FS/10/024) from the British Heart Foundation. Mr. Tastet and Ms. Shen were supported by a doctoral scholarship from Fonds de Recherche en Santé-Québec (FRSQ). Dr. Dweck is the recipient of the Sir Jules Thorn Award for Biomedical Research 2015 (15/JTA). Dr. Pibarot holds the Canada Research Chair in Valvular Heart Diseases from CIHR; and has received funding from Edwards Lifesciences and Medtronic for echocardiography CoreLab analyses with not personal compensation. Dr. Capoulade was supported by a postdoctoral fellowship grant from CIHR. Dr. Newby is supported by the British Heart Foundation (CH/09/002/26360, RE/13/3/30183); and is the recipient of a Wellcome Trust Senior Investigator Award (WT103782AIA). Dr. Clavel has received a Corelab contract with Edwards Lifesciences; and a research grant from Medtronic without personal compensation. Drs. Clavel, Arsenault, Larose, and Beaudoin are research scholars from Fonds de Recherche en Santé-Québec. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 13, 2019.
- Revision received June 13, 2019.
- Accepted June 14, 2019.
- 2020 American College of Cardiology Foundation
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