Sex-related differences in myocardial fibrosis among patients with aortic stenosis: A systematic review and meta-analysis

Paul Onyeji; S.S. Dani; Sonise Momplaisir-Onyeji; M Lenzi; Paweł Łajczak; Felipe S. Passos; Letizia Consoli; Hristo Kirov; Torsten Doenst; Túlio Caldonazo

doi:10.1016/j.ijcha.2025.101814

October 1, 2025IJC Heart & VasculatureOpen Access

Sex-related differences in myocardial fibrosis among patients with aortic stenosis: A systematic review and meta-analysis

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Why the study?

This study evaluated sex-related differences in myocardial fibrosis among patients with aortic stenosis using CMR parameters.

Are there sex-related differences in myocardial fibrosis measured by cardiac magnetic resonance in patients with aortic stenosis?

Structured PICO

Are there sex-related differences in myocardial fibrosis measured by cardiac magnetic resonance in patients with aortic stenosis?

P

Population

2,105 patients with aortic stenosis (1,246 males) pooled from 7 studies

I

Intervention

Male sex

C

Comparator

Female sex

O

Outcome

Late gadolinium enhancement (LGE%), infarct-related and non-infarct-related LGE, extracellular volume (ECV) and Septal E/e'surrogate

In patients with aortic stenosis, men exhibit more focal replacement fibrosis (non-infarct LGE) compared to women, highlighting sex-specific patterns of myocardial remodeling.

Implication

May inform sex-specific fibrosis surveillance in aortic stenosis; extends meta-analytic evidence on differential remodeling.

Abstract

Background: -analysis aimed to evaluate sex-related differences in myocardial fibrosis using cardiac magnetic resonance (CMR) parameters. Methods: Three databases were searched for studies comparing male and female patients with AS reporting CMR-derived measures. The primary outcomes were late gadolinium enhancement (LGE%), infarct-related and non-infarct-related LGE, extracellular volume (ECV) and Septal E/e'. Effect sizes were expressed as risk ratios (RR) for binary outcomes and mean differences (MD) for continuous outcomes, each with 95% confidence intervals (CI), using random-effects models. Study quality was appraised with the Newcastle-Ottawa Scale, and certainty of evidence was graded using the GRADE framework. Results: Seven studies (n = 2,105; 1,246 males) were included. No significant difference was observed in LGE% (MD 0.13; 95 %CI -0.93 to 1.18; p = 0.770), and risks of infarct-related LGE between sexes (RR 1.61; 95 %CI 0.90 to 2.89; p = 0.080). Males had higher risk of non-infarct LGE (RR 1.51; 95 %CI 1.34 to 1.70; p = 0.002). There were no significant differences in ECV (MD -0.45; 95 %CI -2.34 to 1.44; p = 0.506) and Septal E/e' between sexes (MD -1.87; 95 %CI -4.05 to 0.32; p = 0.072). Conclusion: -analysis shows sex-related differences in myocardial fibrosis in AS, with men exhibiting more focal replacement fibrosis and women a tendency toward diffuse interstitial fibrosis. These patterns highlight the relevance of incorporating sex-specific factors into diagnosis and management.