Chehab Omar, Shabani Mahsima, Varadarajan Vinithra, Wu Collin O, Watson Karol E, Yeboah Joseph, Post Wendy S, Ambale-Venkatesh Bharath, Bluemke David A, Michos Erin, Lima João A C
Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
JACC Adv. 2023 May;2(3). doi: 10.1016/j.jacadv.2023.100320. Epub 2023 May 10.
Sex hormone (SH) imbalances have been linked to a higher risk of heart failure in both sexes. However, mechanisms that underlie this relationship remain unclear. We examined the association of baseline SH with interstitial and replacement myocardial fibrosis in the MESA (Multi-Ethnic Study of Atherosclerosis) using cardiac magnetic resonance (CMR) T1 mapping and late gadolinium enhancement (LGE).
The purpose of this study was to assess the link between baseline sex hormone levels and myocardial fibrosis in the MESA cohort using CMR.
A total of 2,324 participants (men and postmenopausal women [PMW]) were included in the MESA with SH measured at baseline and had underwent CMR 10 years later. All analyses were stratified by sex and age. Regression models were constructed to assess the associations of baseline SH with extracellular volume (ECV)% and native T1 time and with LGE. Higher native T1 time and ECV% are interpreted as evidence of increasing interstitial myocardial fibrosis (IMF). Given the limited number of myocardial scars present in PMW, analysis of LGE was limited to men.
Among older men (age ≥65 years), a 1-SD increment higher free testosterone was significantly associated with 2.45% lower ECV% and 21.5% lower native T1 time, while a 1-SD increment higher bioavailable testosterone was associated with 12.5% lower native T1 time. A 1-SD increment greater sex hormone-binding globulin level was associated with 1% higher ECV%. Among PMW of 55 to 64 years, a 1-SD increment higher total testosterone was associated with 9.5% lower native T1 time. Higher levels of estradiol in older men were independently associated with higher odds of having a myocardial scar (OR: 4.10; 95% CI: 1.35-12.40; = 0.01).
Among older men, SH imbalances at initial evaluation were independently associated with CMR defined IMF and replacement fibrosis, respectively; while increasing total testosterone in middle-aged PMW was associated with lesser marker of IMF. (JACC Adv 2023;2:100320) Published by Elsevier on behalf of the American College of Cardiology Foundation.
性激素（SH）失衡与两性心力衰竭风险升高有关。然而，这种关系背后的机制仍不清楚。我们使用心脏磁共振（CMR）T1映射和延迟钆增强（LGE），在动脉粥样硬化多族裔研究（MESA）中研究了基线SH与间质和替代性心肌纤维化的关联。
本研究的目的是使用CMR评估MESA队列中基线性激素水平与心肌纤维化之间的联系。
共有2324名参与者（男性和绝经后女性[PMW]）纳入MESA，在基线时测量了SH，并在10年后接受了CMR检查。所有分析均按性别和年龄分层。构建回归模型以评估基线SH与细胞外容积（ECV）%、固有T1时间以及与LGE的关联。较高的固有T1时间和ECV%被解释为间质心肌纤维化（IMF）增加的证据。鉴于PMW中存在的心肌瘢痕数量有限，LGE分析仅限于男性。
在老年男性（年龄≥65岁）中，游离睾酮每增加1个标准差，ECV%显著降低2.45%，固有T1时间显著降低21.5%，而生物可利用睾酮每增加1个标准差，固有T1时间降低12.5%。性激素结合球蛋白水平每增加1个标准差，ECV%升高1%。在55至64岁的PMW中，总睾酮每增加1个标准差，固有T1时间降低9.5%。老年男性中较高的雌二醇水平与心肌瘢痕形成几率较高独立相关（OR：4.10；95%CI：1.35 - 12.40；P = 0.01）。
在老年男性中，初始评估时的SH失衡分别与CMR定义的IMF和替代性纤维化独立相关；而中年PMW中总睾酮增加与IMF标志物减少有关。（《美国心脏病学会杂志·进展》2023年；2：100320）由爱思唯尔代表美国心脏病学会基金会出版。
