Department of Cardiology, Beijing Jishuitan Hosptial, No. 31 East Street, Xinjiekou, XiCheng, Beijing, 100035, China.
Department of Cardiology, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, XiCheng, Beijing, 100037, China.
Biol Sex Differ. 2022 Jul 7;13(1):37. doi: 10.1186/s13293-022-00447-x.
Alcohol septal ablation (ASA) has been proven to reverse left ventricular (LV) remodeling in hypertrophic cardiomyopathy (HCM). However, there are no studies on the effect of sex on LV remodeling after ASA. We aimed to investigate whether sex differences affect the process of LV remodeling and outcome after ASA.
A total of 107 patients with obstructive HCM (54 men and 53 women, mean age 51 ± 8 years) were recruited. Cardiovascular magnetic resonance (CMR) was performed at baseline and 16 months after ASA. The extent of late gadolinium enhancement (LGE) was measured.
Women had a higher indexed LV mass and smaller indexed LV end-systolic volumes than men at the time of ASA. After ASA, both men and women exhibited a regression of LV mass, and the percentage of mass regression was greater in men than women (15.3% ± 4.3% vs. 10.7% ± 1.8%, p < 0.001). In multivariable analysis, male sex, higher reduction of LV outflow tract (LVOT) gradient and lower baseline LV mass index were independently associated with greater LV mass regression after ASA. Kaplan-Meier analysis showed significantly higher cardiovascular events in women than in men (p = 0.015). Female sex [hazard ratio (HR) 3.913, p = 0.038] and LV mass preablation (HR, 1.019, p = 0.010) were independent predictors of cardiovascular outcomes.
Males with HCM had favorable reverse remodeling with greater LV mass regression post-ASA than female patients. This favorable LV reverse remodeling might provide a mechanistic explanation for the survival advantage in men.
酒精室间隔消融术（ASA）已被证明可逆转肥厚型心肌病（HCM）患者的左心室（LV）重构。然而，目前尚无研究探讨性别对 ASA 后 LV 重构的影响。我们旨在研究性别差异是否会影响 ASA 后 LV 重构的过程和结局。
共纳入 107 例梗阻性 HCM 患者（54 名男性，53 名女性，平均年龄 51±8 岁）。所有患者均在 ASA 术前和术后 16 个月行心血管磁共振（CMR）检查，并测量延迟钆增强（LGE）程度。
ASA 时，女性的 LV 质量指数和 LV 收缩末期容积指数均高于男性。ASA 后，男女患者的 LV 质量均出现逆转，且男性的质量逆转程度大于女性（15.3%±4.3% vs. 10.7%±1.8%，p<0.001）。多变量分析显示，男性、LVOT 梯度降低程度更大和基线时 LV 质量指数更低与 ASA 后 LV 质量的更大逆转相关。Kaplan-Meier 分析显示女性的心血管事件发生率明显高于男性（p=0.015）。女性性别（HR 3.913，p=0.038）和术前 LV 质量（HR 1.019，p=0.010）是心血管结局的独立预测因素。
与女性患者相比，HCM 男性患者 ASA 后具有更好的 LV 逆向重构，LV 质量的更大逆转可能为男性患者的生存优势提供机制解释。
