Sex differences in aortic stenosis: Identification of knowledge gaps for sex-specific personalized medicine

Figures

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  Fig. 1. Mechanisms of aortic valve calcification (AVC). (Abb.: Akt = kinase; PI = phosphorylation; IFN-α = interferon alfa; PG E2 = prostaglandin E2; BSP2 = bone sialoprotein 2; RUNX2 = runt-related transcription factor-2; SOST = osteocyte marker sclerotin; TNAP = tissue nonspecific alkaline phosphatase; MGP = mineralization inhibitor matrix-Gla protein.)

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  Fig. 2. Sex-related differences in geometric patterns of LV response to pressure overload. Patterns of cardiac remodeling according to relative wall thickness and LV mass index. Each type of LV geometry is illustrated by lines representing M-mode images. (Abb.: LV = left ventricle; S = septum; EDD = end-diastolic diameter; ESD = end-systolic diameter; PW = posterior wall.)

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  Fig. 3. Sex differences in expansion of myocardial fibrosis in aortic stenosis. Compared to men, women have similar amounts of replacement myocardial fibrosis (=LGE) and larger extent of diffuse myocardial fibrosis (=ECV). (Abb.: CMR = cardiac magnetic resonance; LGE = late gadolinium enhancement; ECV = extra cellular volume.)

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  Fig. 4. Molecular mechanisms underlying myocardial fibrosis and LV remodeling. Myocardial fibrosis: in men, mainly driven by LV hypertrophy and AS severity, and more cardiomyocyte loss but in women the response to pressure overload is more heterogeneous. (Abb: RAAS = renin-angiotensin-aldosterone system; RNL = renalase.)

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  Fig. 5. Treatment options in severe aortic stenosis and women specific characteristics. (Abb.: SAVR = surgical aortic valve replacement; TAVR = transcatheter aortic valve replacement; AS = aortic stenosis.)

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  Central illustration. Illustrative representation of sex-related differences in aortic stenosis. (Abb.: AVC = aortic valve calcification; AS = aortic stenosis; RV = right ventricle; LV = left ventricle; LGE = late gadolinium enhancement; ECV = extra cellular volume; EDV = end diastolic volume; BMI=body mass index; HTN=hypertension; CAD=coronary artery disease; PAD=peripheral artery disease; SOB=shortness of breath; GFR = glomerular filtration rate.)