Gender Difference in Ventricular Response to Aortic Stenosis: Insight from Cardiovascular Magnetic Resonance

<div><p>Background</p><p>Although left ventricular hypertrophy (LVH) and remodeling is associated with cardiac mortality and morbidity, little is known about the impact of gender on the ventricular response in aortic stenosis (AS) patients. This study aimed to analyze the differential effect of gender on ventricular remodeling in moderate to severe AS patients.</p><p>Methods and Results</p><p>A total of 118 consecutive patients (67±9 years; 63 males) with moderate or severe AS (severe 81.4%) underwent transthoracic echocardiography and cardiovascular magnetic resonance (CMR) within a 1-month period in this two-center prospective registry. The pattern of LV remodeling was assessed using the LV mass index (LVMI) and LV remodeling index (LVRI; LV mass/LV end-diastolic volume) by CMR. Although there were no differences in AS severity parameters nor baseline characteristics between genders, males showed a significantly higher LVMI (102.6±29.1g/m² vs. 86.1±29.2g/m², p=0.003) and LVRI (1.1±0.2 vs. 1.0±0.3, p=0.018), regardless of AS severity. The LVMI was significantly associated with aortic valve area (AVA) index and valvuloarterial impedance in females, whereas it was not in males, resulting in significant interaction between genders (PInteraction=0.007/0.014 for AVA index/valvuloarterial impedance, respectively). Similarly, the LVRI also showed a significantly different association between male and female subjects with the change in AS severity parameters (PInteraction=0.033/<0.001/0.029 for AVA index/transaortic mean pressure gradient/valvuloarterial impedance, respectively).</p><p>Conclusion</p><p>Males are associated with greater degree of LVH and higher LVRI compared to females at moderate to severe AS. However, females showed a more exaggerated LV remodeling response, with increased severity of AS and hemodynamic loads, than males.</p></div

Baseline clinical characteristics of the study participants.

<p>The data are presented as mean (SD) or number (percentage).</p><p>Abbreviations: ACEI/ARB, angiotensin converting enzyme inhibitor/angiotensin receptor blocker; BMI, body mass index; HTN, hypertension; NYHA, New York Heart Association.</p><p>Baseline clinical characteristics of the study participants.</p

Echocardiographic and cardiovascular magnetic resonance (CMR) parameters of the study participants.

<p>The data are presented as mean (SD), except adjusted mean (SE) in the body mass index adjusted LV mass.</p><p>^†When quantifying the LV mass, the trabeculations and the papillary muscles were excluded.</p><p>Abbreviations: AR, aortic regurgitation; AS, aortic stenosis; AVA, aortic valve area; BMI, body mass index; BSA, body surface area; E, early diastolic velocity at the mitral valve tip; e’, early mitral annular velocity at the septal annulus; IVST, interventricular septal thickness; LV, left ventricle; PG, pressure gradient; PWT, posterior wall thickness; Vmax, maximal transaortic velocity; Z_VA, valvuloarterial impedance.</p><p>Echocardiographic and cardiovascular magnetic resonance (CMR) parameters of the study participants.</p

The association between left ventricular remodeling index and the severity of aortic stenosis or valvuloarterial impedance.

<p>Males consistently showed relatively higher left ventricular remodeling index in (A) larger aortic valve area index, (B) lower mean transaortic pressure gradient, or (C) lower valvuloarterial impedance, compared with females. However, there were significant differences between the two genders in the degree of correlation between the left ventricular remodeling index and the above three parameters. The univariate linear regression coefficient and the interaction p value across the gender are shown. Abbreviations: AV, aortic valve; AVA, aortic valve area; CMR, cardiovascular magnetic resonance; PG, pressure gradient.</p