Sex differences in atrial remodeling and its relationship with myocardial fibrosis in hypertrophic obstructive cardiomyopathy

Figures

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  FIGURE 1. Cardiac magnetic resonance (CMR) images of left atrial (LA) and histological images of myocardium from a control subject (the top panel), a male patient with hypertrophic obstructive cardiomyopathy (HOCM) (the middle panel), and a female patient with HOCM (the bottom panel). The first column is CMR images of the minimum LA volume after atrial contraction in the two-chambered view (Control: a, Male: e, Female: i). The second column is CMR images of the maximal LA volume before the mitral valve opening in the two-chambered view (Control: b, Male: f, Female: j). The third column is the images of myocardial fibrosis (blue) stained with Masson’s trichrome (Control: c, Male: g, Female: k). The fourth column is volume-time curves (black) and their first derivatives (red) of the left atrium (Control: d, Male: h, Female: l). LA V/T curves after the first peak and dV/dt curves under the coordinate axis represent the process of LA emptying. The first negative peak, representing maximal emptying during the conduit phase, is identified as the early atrial peak emptying rate (PER-E). The second peak, during the booster phase, is identified as the late atrial peak emptying rate (PER-A).

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  FIGURE 2. Sex differences in collagen volume fraction (CVF) and left atrial (LA) deformation rates in patients with hypertrophic obstructive cardiomyopathy (HOCM). Female patients showed higher CVF (A), but lower peak of emptying rate (PER-E) (B), and PER-E index (C) than males. When stratifying patients by the CVF values, the sex differences in CVF (D) and PER-E index (F) were eliminated in the subgroups with normal and high CVF, but in PER-E (E), the sex differences remained significant in the subgroup with high CVF.

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  FIGURE 3. Correlations between collagen volume fraction (CVF) and left atrial (LA) deformation rates in both sexes. CVF was significantly correlated with PER-E and PER-E index in males (A,C) and females (B,D).