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August 29, 2019HeartOpen Access

Sex differences in left ventricular remodelling, myocardial fibrosis and mortality after aortic valve replacement

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Why the study?

Sex differences in left ventricular remodelling and clinical outcomes in patients undergoing SAVR or TAVR needed investigation.

Are there sex differences in left ventricular remodelling, myocardial fibrosis, and mortality in patients undergoing SAVR or TAVR for severe aortic stenosis?

Population

674 patients with severe aortic stenosis listed for SAVR or TAVR at six UK centres

Comparison

Men vs women

Design

Multicentre prospective observational study

Follow-up

Median 3.6 years

Key result

Following aortic valve replacement, women had similar all-cause mortality to men (20.5% vs 23.3%, p=0.114) but higher cardiovascular mortality (13.7% vs 8.5%, p=0.012).

Authors

ASAnvesha SinghTMTarique Al MusaTTThomas A. Treibel

Discussion

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Overview

Higher CV mortality in women post-AVR may warrant enhanced monitoring; leaves open whether baseline risks or sex-specific remodelling drive outcomes.

Key Points

  • To evaluate sex differences in left ventricular remodelling, myocardial fibrosis, and survival outcomes among patients undergoing surgical or transcatheter aortic valve replacement.
  • Prospective observational study across six UK centres evaluating 674 patients with severe aortic stenosis undergoing SAVR (n=399) or TAVR (n=275; 425 men, 249 women; mean age 75±14 years).
  • Participants underwent cardiovascular magnetic resonance imaging with core-laboratory analysis and were monitored for a median follow-up of 3.6 years for all-cause and cardiovascular mortality.
  • Men exhibited more advanced ventricular remodelling and a higher frequency of bicuspid aortic valves (26.7% vs 14.9%, p<0.001), whereas women were older, had higher surgical risk scores, and underwent TAVR more frequently (53% vs 33.6%, p<0.001).
  • All-cause mortality did not differ significantly between sexes (23.3% in men vs 20.5% in women, p=0.114), but cardiovascular mortality was significantly higher in women (13.7% vs 8.5%, p=0.012), with no sex-related mortality difference remaining in subgroup analyses.
  • Myocardial fibrosis detected by late gadolinium enhancement and advanced age were independent predictors of cardiovascular mortality across both sexes.

Study Design

Type

Observational (n=674)

Multicenter

Yes

Structured PICO

Are there sex differences in left ventricular remodelling, myocardial fibrosis, and mortality in patients undergoing SAVR or TAVR for severe aortic stenosis?

P
Population
674 patients (425 men, 249 women, age 75±14 years) with severe aortic stenosis listed for surgical or transcatheter aortic valve replacement at one of six UK centres
I
Intervention
Surgical or transcatheter aortic valve replacement (SAVR/TAVR)
C
Comparator
Comparison between sexes (men vs women)
O
Outcome
All-cause mortalityhard clinical

Main Result

Absolute Event Rate: 20.5% vs 23.3%

p-value: p=0.114

Men demonstrate more advanced LV remodelling in severe AS, while higher cardiovascular mortality in women post-AVR is driven by higher baseline risk and less bicuspid anatomy rather than sex itself.

Cite This Study

Singh et al. (2019) conducted an observational in severe aortic stenosis (n=674). Female sex vs. Male sex was evaluated on all-cause mortality (p=0.114). Following aortic valve replacement, women had similar all-cause mortality to men (20.5% vs 23.3%, p=0.114) but higher cardiovascular mortality (13.7% vs 8.5%, p=0.012).

synapsesocial.com/papers/6a0f9d1d8594bc049cf9325fhttps://doi.org/10.1136/heartjnl-2019-314987
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