PMID- 31467152
OWN - NLM
STAT- MEDLINE
DCOM- 20200611
LR  - 20230222
IS  - 1468-201X (Electronic)
IS  - 1355-6037 (Print)
IS  - 1355-6037 (Linking)
VI  - 105
IP  - 23
DP  - 2019 Dec
TI  - Sex differences in left ventricular remodelling, myocardial fibrosis and 
      mortality after aortic valve replacement.
PG  - 1818-1824
LID - 10.1136/heartjnl-2019-314987 [doi]
AB  - OBJECTIVES: To investigate sex differences in left ventricular remodelling and 
      outcome in patients undergoing surgical or transcatheter aortic valve replacement 
      (SAVR/TAVR). METHODS: In this multicentre, observational, outcome study with 
      imaging core-lab analysis, patients with severe aortic stenosis (AS) listed for 
      intervention at one of six UK centres were prospectively recruited and underwent 
      cardiovascular magnetic resonance imaging. The primary endpoint was all-cause 
      mortality and secondary endpoint was cardiovascular mortality. RESULTS: 674 
      patients (425 men, 249 women, age 75+/-14 years) were included: 399 SAVR, 275 TAVR. 
      Women were older, had higher surgical risk scores and underwent TAVR more 
      frequently (53% vs 33.6%, p<0.001). More men had bicuspid aortic valves (BAVs) 
      (26.7% vs 14.9%, p<0.001) and demonstrated more advanced remodelling than women. 
      During a median follow-up of 3.6 years, 145 (21.5%) patients died, with no 
      significant sex difference in all-cause mortality (23.3% vs 20.5%, p=0.114), but 
      higher cardiovascular mortality in women (13.7% vs 8.5%, p=0.012). There were no 
      significant sex-related differences in outcome in the SAVR or TAVR subgroups, or 
      after excluding those with BAV. Factors independently associated with all-cause 
      mortality were age, left ventricular ejection fraction (LVEF), BAV (better) and 
      myocardial fibrosis detected with late gadolinium enhancement (LGE) in men, and 
      age, LVEF and LGE in women. Age and LGE were independently associated with 
      cardiovascular mortality in both sexes. CONCLUSIONS: Men demonstrate more 
      advanced remodelling in response to a similar severity of AS. The higher 
      cardiovascular mortality observed in women following AVR is accounted for by 
      women having less BAV and higher risk scores resulting in more TAVR. LGE is 
      associated with a worse prognosis in both sexes.
CI  - (c) Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published 
      by BMJ.
FAU - Singh, Anvesha
AU  - Singh A
AUID- ORCID: 0000-0003-1112-3973
AD  - Cardiovascular Sciences, University of Leicester and the NIHR Leicester 
      Biomedical Research Centre, Glenfield Hospital, Leicester, UK.
FAU - Musa, Tarique Al
AU  - Musa TA
AD  - Cardiovascular Sciences, Multidisciplinary Cardiovascular Research Centre and The 
      Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic 
      Medicine, University of Leeds, Leeds, UK.
FAU - Treibel, Thomas A
AU  - Treibel TA
AD  - Cardiovascular Sciences, Barts Health NHS Trust and University College London, 
      London, UK.
FAU - Vassiliou, Vassiliou S
AU  - Vassiliou VS
AD  - Cardiovascular Sciences, Imperial College London, Royal Brompton Hospital, 
      London, UK.
AD  - University of East Anglia and Norfolk and Norwich University Hospitals, Norwich, 
      Norfolk, United Kingdom.
FAU - Captur, Gabriella
AU  - Captur G
AD  - Cardiovascular Sciences, Barts Health NHS Trust and University College London, 
      London, UK.
FAU - Chin, Calvin
AU  - Chin C
AUID- ORCID: 0000-0002-9867-4390
AD  - Cardiovascular Medicine, National Heart Center Singapore, Singapore, Singapore.
FAU - Dobson, Laura E
AU  - Dobson LE
AD  - Cardiovascular Sciences, Multidisciplinary Cardiovascular Research Centre and The 
      Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic 
      Medicine, University of Leeds, Leeds, UK.
FAU - Pica, Silvia
AU  - Pica S
AD  - Cardiovascular Sciences, Barts Health NHS Trust and University College London, 
      London, UK.
FAU - Loudon, Margaret
AU  - Loudon M
AD  - Cardiovascular Sciences, University of Oxford Centre for Clinical Magnetic 
      Resonance Research, Oxford, UK.
FAU - Malley, Tamir
AU  - Malley T
AD  - Cardiovascular Sciences, Imperial College London, Royal Brompton Hospital, 
      London, UK.
FAU - Rigolli, Marzia
AU  - Rigolli M
AD  - Cardiovascular Sciences, University of Oxford Centre for Clinical Magnetic 
      Resonance Research, Oxford, UK.
FAU - Foley, James Robert John
AU  - Foley JRJ
AD  - Cardiovascular Sciences, Multidisciplinary Cardiovascular Research Centre and The 
      Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic 
      Medicine, University of Leeds, Leeds, UK.
FAU - Bijsterveld, Petra
AU  - Bijsterveld P
AD  - Cardiovascular Sciences, Multidisciplinary Cardiovascular Research Centre and The 
      Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic 
      Medicine, University of Leeds, Leeds, UK.
FAU - Law, Graham R
AU  - Law GR
AD  - Medical Statistics, School of Health and Social Care, University of Lincoln and 
      Multidisciplinary Cardiovascular Research Centre and The Division of Biomedical 
      Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of 
      Leeds, Lincoln and Leeds, UK.
FAU - Dweck, Marc Richard
AU  - Dweck MR
AD  - Cardiovascular Sciences, Centre for Cardiovascular Science, University of 
      Edinburgh, Edinburgh, UK marcdweck@hotmail.com.
FAU - Myerson, Saul G
AU  - Myerson SG
AUID- ORCID: 0000-0001-5927-0230
AD  - Cardiovascular Sciences, University of Oxford Centre for Clinical Magnetic 
      Resonance Research, Oxford, UK.
FAU - Prasad, Sanjay K
AU  - Prasad SK
AD  - Cardiology, Royal Brompton Hospital, London, UK.
FAU - Moon, James C
AU  - Moon JC
AD  - Cardiovascular Sciences, Barts Health NHS Trust and University College London, 
      London, UK.
FAU - Greenwood, John P
AU  - Greenwood JP
AD  - Cardiovascular Sciences, Multidisciplinary Cardiovascular Research Centre and The 
      Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic 
      Medicine, University of Leeds, Leeds, UK.
FAU - McCann, Gerry P
AU  - McCann GP
AD  - Cardiovascular Sciences, University of Leicester and the NIHR Leicester 
      Biomedical Research Centre, Glenfield Hospital, Leicester, UK.
LA  - eng
GR  - FS/10/015/28104/BHF_/British Heart Foundation/United Kingdom
GR  - PG/11/126/29321/BHF_/British Heart Foundation/United Kingdom
GR  - FS/17/34/32901/BHF_/British Heart Foundation/United Kingdom
GR  - PDF-2011-04-051/DH_/Department of Health/United Kingdom
GR  - FS/10/026/28209/BHF_/British Heart Foundation/United Kingdom
GR  - FS/08/028/24767/BHF_/British Heart Foundation/United Kingdom
GR  - PG/07/068/2334/BHF_/British Heart Foundation/United Kingdom
GR  - RP-2017-08-ST2-007/DH_/Department of Health/United Kingdom
GR  - FS/10/40/28260/BHF_/British Heart Foundation/United Kingdom
GR  - FS/14/78/31020/BHF_/British Heart Foundation/United Kingdom
GR  - FS/10/026/BHF_/British Heart Foundation/United Kingdom
GR  - DRF-2013-06-102/DH_/Department of Health/United Kingdom
GR  - FS/16/31/32185/BHF_/British Heart Foundation/United Kingdom
PT  - Journal Article
PT  - Multicenter Study
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20190829
PL  - England
TA  - Heart
JT  - Heart (British Cardiac Society)
JID - 9602087
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Aortic Valve/diagnostic imaging/surgery
MH  - Aortic Valve Stenosis/diagnostic imaging/mortality/*surgery
MH  - Echocardiography
MH  - Female
MH  - Fibrosis
MH  - Heart Valve Prosthesis Implantation/*methods/mortality
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Longitudinal Studies
MH  - Male
MH  - Middle Aged
MH  - Myocardium/*pathology
MH  - Postoperative Period
MH  - Prognosis
MH  - *Sex Characteristics
MH  - United Kingdom/epidemiology
MH  - Ventricular Remodeling/*physiology
PMC - PMC6900227
OTO - NOTNLM
OT  - AVR
OT  - CMR
OT  - aortic stenosis
COIS- Competing interests: None declared.
EDAT- 2019/08/31 06:00
MHDA- 2020/06/12 06:00
PMCR- 2019/12/08
CRDT- 2019/08/31 06:00
PHST- 2019/02/28 00:00 [received]
PHST- 2019/06/07 00:00 [revised]
PHST- 2019/06/08 00:00 [accepted]
PHST- 2019/08/31 06:00 [pubmed]
PHST- 2020/06/12 06:00 [medline]
PHST- 2019/08/31 06:00 [entrez]
PHST- 2019/12/08 00:00 [pmc-release]
AID - heartjnl-2019-314987 [pii]
AID - 10.1136/heartjnl-2019-314987 [doi]
PST - ppublish
SO  - Heart. 2019 Dec;105(23):1818-1824. doi: 10.1136/heartjnl-2019-314987. Epub 2019 
      Aug 29.