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Gender influences left ventricular remodelling in the setting of aortic stenosis but does not appear to impact on reverse remodelling following transcatheter aortic valve implantation
Journal of Cardiovascular Magnetic Resonance volume 17, Article number: P332 (2015)
Left ventricular (LV) remodelling in the setting of the chronic pressure overload of aortic stenosis (AS) appears to differ according to gender. Women appear to have an improved survival compared to men following transcatheter aortic valve implantation (TAVI) but the reasons for this are yet to be established. Potential mechanisms include differing patterns of LV reverse remodelling, LV fibrosis regression and reduced aortic regurgitation in females. We sought to establish using cardiac magnetic resonance (CMR) imaging, the reference standard non-invasive technique for LV mass and scar quantification, whether there were any gender differences in these parameters before and after TAVI.
53 patients with symptomatic severe aortic stenosis undergoing TAVI were prospectively enrolled between April 2009 and March 2014. Patients with contraindications to CMR were excluded and all patients provided informed written consent. All patients underwent an identical 1.5T CMR protocol (Intera, Philips) prior to and at a median of 6 months following TAVI (IQR 5-6 months). Multi slice, multiphase imaging was carried out using a standard steady-state free procession pulse sequence in the short axis to cover the entire left ventricle. Late gadolinium enhancement imaging was performed 10min after the administration of 0.2mmol/kg of gadoteric acid (Doteram, Guerbet, Villepinte). Quantitative analysis was performed using dedicated computer software (CVI42, Circle Cardiovascular Imaging, Alberta, Canada).
Basic clinical, echocardiographic and procedural characteristics can be seen in Table 1. Women with severe AS have a smaller indexed LV mass (LVMi) (69.6 ± 18.8g/m2 Vs 81.8 ± 21.6g/m2,p=0.03) less baseline myocardial scar (1.7±2.5g Vs 5.0 ± 5.7g, p=0.01) and a smaller indexed LV end diastolic volume (LVEDVi) than men (90.2 ± 17ml/m2 Vs. 105 ± 27.7 ml/m2;p=0.03). A trend towards a smaller indexed left atrial volume (LAVi) (63.7 ± 17.2ml/m2 Vs 74.2 ± 23.5ml/m2, p=0.08) and better ejection fraction (57.9 ± 11.4% Vs 52.6 ± 13.8%, p=0.15) was also seen in women when compared with men. Six months following TAVI, there was no significant difference seen between genders with regards to LV mass regression, change in ejection fraction, change in myocardial scar burden, change in left atrial volume or change in aortic regurgitant fraction (Table 2).
In the setting of the chronic pressure overload of aortic stenosis, there appears to be a difference in LV remodelling between genders with a smaller LV cavity, less fibrosis and a lower LV mass in women compared with men. Six months following TAVI, there did not appear to be a significant difference in LV reverse remodelling, change in myocardial scar burden or aortic regurgitant fraction according to gender.
This study was part funded by the British Heart Foundation (BHF) (PG/11/126/29321).
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Dobson, L.E., Musa, T.A., Uddin, A. et al. Gender influences left ventricular remodelling in the setting of aortic stenosis but does not appear to impact on reverse remodelling following transcatheter aortic valve implantation. J Cardiovasc Magn Reson 17, P332 (2015). https://doi.org/10.1186/1532-429X-17-S1-P332
- Cardiac Magnetic Resonance
- Aortic Stenosis
- Late Gadolinium Enhancement
- Left Ventricular Mass
- Transcatheter Aortic Valve Implantation