Kocyigit Burunkaya Duygu, Obuchowski Nancy A, Ho Natalie, Popovic Zoran B, Chen David, Nguyen Christopher, Tang W H Wilson, Kwon Deborah H
Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44196, USA.
Eur Heart J Imaging Methods Pract. 2025 Mar 19;3(1):qyaf021. doi: 10.1093/ehjimp/qyaf021. eCollection 2025 Jan.
Sex differences in prognosis of functional mitral regurgitation (FMR) associated with ischaemic cardiomyopathy (ICM) demonstrate the need to identify sex differences in cardiac remodelling. This study aimed to characterize sex differences in cardiac remodelling associated with FMR in the setting of ICM, sex interactions with cardiac remodelling and FMR severity, and predictors of all-cause mortality or heart transplantation using cardiac magnetic resonance (CMR) imaging.
Consecutive patients with ICM referred to CMR between 2002 and 2017 were reviewed. Eligible 790 patients [mean age: 62.0 (standard deviation = 11.2] years and 24.7% females] were evaluated over a median follow-up of 5.8 years. There were 773 subjects with complete data for survival analysis, with 449 primary events. Coronary artery disease risk factors, medications, and previous coronary revascularization were similar in females and males (all > 0.05). Indexed left ventricular and right ventricular (LV and RV) volumes were larger in males ( < or =0.005 for all comparisons) with similar slope of increasing LV and RV volumes in the setting of increasing FMR (all > 0.05, for interactions). However, indexed left atrial volume was similar in males and females ( = 0.696), after adjusting for FMR severity. After adjusting for medical risk factors and post-CMR procedural interventions, females demonstrated increased risk of primary clinical composite point with enlarging LV volumes [hazard ratio: 1.04 (95% confidence interval: 1.01-1.06), = 0.034].
Because females with increasing LV size and FMR severity demonstrated significantly increased risk of adverse outcomes, our findings suggest the importance of deriving sex-specific CMR selection criteria for therapeutic management of FMR in the setting of ICM.
缺血性心肌病（ICM）相关功能性二尖瓣反流（FMR）的预后存在性别差异，这表明有必要识别心脏重塑过程中的性别差异。本研究旨在通过心脏磁共振成像（CMR）来描述ICM背景下与FMR相关的心脏重塑的性别差异、性别与心脏重塑及FMR严重程度的相互作用，以及全因死亡率或心脏移植的预测因素。
回顾了2002年至2017年间因ICM接受CMR检查的连续患者。符合条件的790例患者[平均年龄：62.0（标准差=11.2）岁，女性占24.7%]在中位随访期5.8年期间接受了评估。有773例受试者有完整数据用于生存分析，其中449例发生主要事件。女性和男性的冠状动脉疾病危险因素、药物治疗及既往冠状动脉血运重建情况相似（均P>0.05）。男性的左心室和右心室（LV和RV）指数容积更大（所有比较均P≤0.005），在FMR增加的情况下，LV和RV容积增加的斜率相似（所有相互作用均P>0.05）。然而，在调整FMR严重程度后男性和女性的左心房指数容积相似（P=0.696）。在调整医学危险因素和CMR术后程序干预后，随着LV容积增大，女性发生主要临床复合终点的风险增加[风险比：1.04（95%置信区间：1.01-1.06），P=0.034]。
由于LV大小和FMR严重程度增加的女性不良结局风险显著增加，我们的研究结果表明，为ICM背景下FMR的治疗管理制定针对性别的CMR选择标准具有重要意义。
