Cardiovascular MRI Laboratory, Division of Cardiovascular Imaging, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA.
Department of Pathology and Genomic Medicine, Houston Methodist Hospital Research Institute, Houston, TX, USA.
Sci Rep. 2023 Jul 13;13(1):11334. doi: 10.1038/s41598-023-37444-y.
Whether sex differences exist in the cardiac remodeling related to aortic regurgitation (AR) is unclear. Cardiac magnetic resonance (CMR) is the current non-invasive reference standard for cardiac remodeling assessment and can evaluate tissue characteristics. This prospective cohort included patients with AR undergoing CMR between 2011 and 2020. We excluded patients with confounding causes of remodeling. We quantified left ventricular (LV) volume, mass, AR severity, replacement fibrosis by late Gadolinium enhancement (LGE), and extracellular expansion by extracellular volume fraction (ECV). We studied 280 patients (109 women), median age 59.5 (47.2, 68.6) years (P for age = 0.25 between sexes). Women had smaller absolute LV volume and mass than men across the spectrum of regurgitation volume (RVol) (P ≤ 0.01). In patients with ≥ moderate AR and with adjustment for body surface area, indexed LV end-diastolic volume and mass were not significantly different between sexes (all P > 0.5) but men had larger indexed LV end systolic volume and lower LV ejection fraction (P ≥ 0.01). Women were more likely to have NYHA class II or greater symptoms than men but underwent surgery at a similar rate. Prevalence and extent of LGE was not significantly different between sexes or across RVol. Increasing RVol was independently associated with increasing ECV in women, but not in men (adjusted P for interaction = 0.03). In conclusion, women had lower LV volumes and mass than men across AR severity but their ECV increased with higher regurgitant volume, while ECV did not change in men. Indexing to body surface area did not fully correct for the cardiac remodeling differences between men and women. Women were more likely to have symptoms but underwent surgery at a similar rate to men. Further research is needed to determine if differences in ECV would translate to differences in the course of AR and outcomes.
是否存在与主动脉瓣反流（AR）相关的心脏重构的性别差异尚不清楚。心脏磁共振（CMR）是目前评估心脏重构的非侵入性参考标准，可评估组织特征。这项前瞻性队列研究纳入了 2011 年至 2020 年期间接受 CMR 的 AR 患者。我们排除了有混杂原因引起重构的患者。我们量化了左心室（LV）容积、质量、AR 严重程度、晚期钆增强（LGE）的替代纤维化和细胞外容积分数（ECV）的细胞外扩张。我们研究了 280 名患者（109 名女性），中位年龄 59.5（47.2，68.6）岁（性别间年龄差异 P=0.25）。女性在整个反流容积（RVol）范围内的 LV 绝对容积和质量均小于男性（所有 P≤0.01）。在 RVol≥中度 AR 且校正了体表面积后，性别间的指数化 LV 舒张末期容积和质量无显著差异（所有 P>0.5），但男性的指数化 LV 收缩末期容积更大，LV 射血分数更低（P≥0.01）。女性比男性更有可能出现 NYHA 心功能分级 II 级或更高的症状，但手术率相似。性别间或 RVol 范围内 LGE 的患病率和程度无显著差异。在女性中，随着 RVol 的增加，ECV 独立增加，但在男性中则不然（校正性别间交互作用的 P 值=0.03）。总之，女性在整个 AR 严重程度范围内的 LV 容积和质量均小于男性，但女性的 ECV 随着反流量的增加而增加，而男性的 ECV 则无变化。根据体表面积校正并未完全纠正男性和女性之间的心脏重构差异。女性更有可能出现症状，但手术率与男性相似。需要进一步研究以确定 ECV 的差异是否会转化为 AR 病程和结局的差异。
