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

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

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

Efficacy of Short-Term High-Dose Statin Pretreatment in Prevention of Contrast-Induced Acute Kidney Injury: Updated Study-Level Meta-Analysis of 13 Randomized Controlled Trials

<div><p>Background</p><p>There have been conflicting results across the trials that evaluated prophylactic efficacy of short-term high-dose statin pre-treatment for prevention of contrast-induced acute kidney injury (CIAKI) in patients undergoing coronary angiography (CAG). The aim of the study was to perform an up-to-date meta-analysis regarding the efficacy of high-dose statin pre-treatment in preventing CIAKI.</p><p>Methods and Results</p><p>Randomized-controlled trials comparing high-dose statin versus low-dose statin or placebo pre-treatment for prevention of CIAKI in patients undergoing CAG were included. The primary endpoint was the incidence of CIAKI within 2–5days after CAG. The relative risk (RR) with 95% CI was the effect measure. This analysis included 13 RCTs with 5,825 total patients; about half of them (n = 2,889) were pre-treated with high-dose statin (at least 40 mg of atorvastatin) before CAG, and the remainders (n = 2,936) pretreated with low-dose statin or placebo. In random-effects model, high-dose statin pre-treatment significantly reduced the incidence of CIAKI (RR 0.45, 95% CI 0.35–0.57, p<0.001, I² = 8.2%, NNT 16), compared with low-dose statin or placebo. The benefit of high-dose statin was consistent in both comparisons with low-dose statin (RR 0.47, 95% CI 0.34–0.65, p<0.001, I² = 28.4%, NNT 19) or placebo (RR 0.34, 95% CI 0.21–0.58, p<0.001, I² = 0.0%, NNT 16). In addition, high-dose statin showed significant reduction of CIAKI across various subgroups of chronic kidney disease, acute coronary syndrome, and old age (≥60years), regardless of osmolality of contrast or administration of N-acetylcystein.</p><p>Conclusions</p><p>High-dose statin pre-treatment significantly reduced overall incidence of CIAKI in patients undergoing CAG, and emerges as an effective prophylactic measure to prevent CIAKI.</p></div

Clinical outcomes in the total and propensity score-matched populations.

<p>Clinical outcomes in the total and propensity score-matched populations.</p

Kaplan-Meier curves for definite or probable stent thrombosis.

<p>BP-BES = biodegradable polymer biolimus-eluting stent; DAPT = dual antiplatelet therapy; DP-EES = durable polymer everolimus-eluting stent.</p

Kaplan-Meier curves for clinical outcomes in the propensity score-matched cohort.

<p>(A) Target lesion failure. (B) Target lesion failure at 1-year landmark. There were no significant differences of clinical outcomes between 2 groups. BP-BES = biodegradable polymer biolimus-eluting stent; DP-EES = durable polymer everolimus-eluting stent.</p

Detailed description of definite or probable stent thrombosis.

<p>Detailed description of definite or probable stent thrombosis.</p

Study population.

<p>BP-BES = biodegradable polymer biolimus-eluting stent; DP-EES = durable polymer everolimus-eluting stent.</p