JAMA Cardiol. 2025;10(5):446-455.
Sex-Specific Association of Myocardial Fibrosis With Mortality in Patients With Aortic Stenosis.
제1저자 곽순구 · 교신저자 Marc R Dweck, 이승표
소속 (21)
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom.
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
- Barts Health NHS Trust and University College London, London, United Kingdom.
- Department of Public Health Sciences, Seoul National University, Seoul, South Korea.
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
- National Heart Center Singapore, Singapore.
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK and Baker Heart and Diabetes Institute & Monash University, Melbourne, Australia.
- University of Oxford Centre for Clinical Magnetic Resonance Research, BHF Centre of Research Excellence (Oxford), NIHR Biomedical Research Centre (Oxford), Oxford, United Kingdom.
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Université Laval, Québec city, Québec, Canada.
- Charité Campus Buch ECRC and Helios Clinics Cardiology Germany, DZHK partner site, Berlin, Germany.
- Inherited Heart Muscle Disease Clinic, Department of Cardiology, Royal Free Hospital, NHS Foundation Trust, London, United Kingdom.
- Division of Cardiology, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea.
- Allina Health Minneapolis Heart Institute, Minneapolis, Minnesota.
- Division of Cardiology, Department of Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
- Department of Cardiology, German Heart Center Munich, Munich, Germany.
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany.
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St Luc and Institut de Recherche Cardiovasculaire (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium.
- Center for Precision Medicine, Seoul National University Hospital, Seoul, South Korea.
Abstract
IMPORTANCE Myocardial fibrosis in aortic stenosis (AS) may exhibit sex differences. However, its prognostic significance in women with AS remains unclear.
OBJECTIVE To investigate sex differences in myocardial fibrosis assessed by cardiovascular magnetic resonance (CMR) and evaluate its prognostic value in women and men with AS.
DESIGN, SETTING, AND PARTICIPANTS Patients with severe AS who underwent CMR before aortic valve replacement (AVR) were prospectively enrolled from 13 international sites between March 2011 and September 2021. Myocardial fibrosis was evaluated using extracellular volume fraction (ECV%) and late gadolinium enhancement (LGE). The main analysis was conducted on patients without obstructive coronary artery disease (CAD), defined as those with no history of myocardial infarction and no concomitant coronary artery bypass grafting. Data were analyzed from December 2023 to February 2024.
EXPOSURES Surgical or transcatheter AVR.
MAIN OUTCOMES AND MEASURES The primary outcome was post-AVR all-cause mortality and the secondary outcome was cardiovascular mortality.
RESULTS Of 822 patients, 670 were without obstructive CAD (368 men [55%] and 302 women [45%]). Among these, women and men had a similar age (median, 72 years vs 71 years, respectively), comorbidities, and AS severity. ECV% was similar between sexes; however, women had less LGE (both infarct and noninfarct LGE). After a median follow-up of 3.7 (IQR, 2.1-4.7) years, there were 76 deaths (11.3%), including 29 adjudicated cardiovascular deaths, in patients without obstructive CAD. Increasing ECV% and LGE were associated with higher all-cause and cardiovascular mortality in both sexes. Cox analyses demonstrated that both ECV% and LGE were associated with higher all-cause mortality without significant interaction by sex (women: adjusted hazard ratio [HR], 1.08 per 1% ECV% increase; 95% CI, 1.04-1.12; P < .001; men: adjusted HR, 1.01; 95% CI, 0.96-1.06; P = .66; P for interaction by sex = .09 and women: adjusted HR, 2.49 for the presence of LGE; 95% CI, 1.07-5.80; P = .03; men: adjusted HR, 1.82; 95% CI, 1.00-3.32; P = .04; P for interaction by sex = .68). In the entire population (n = 822), both noninfarct and infarct-related LGE were associated with increased mortality without significant interaction by sex.
CONCLUSIONS AND RELEVANCE In this study, patients with severe AS who underwent AVR exhibited similar ECV% between sexes, while women had lower LGE. Increased myocardial fibrosis provided important prognostic value for both sexes.
Conflict of interest statement
Conflict of Interest Disclosures: Dr Williams reported consultant fees from Canon, Feops, Novartis, and Siemens Healthineers outside the submitted work. Dr Fukui reported personal fees from Anteris Technologies and Edwards Lifescience outside the submitted work. Dr Rigolli reported employment from Bristol Myers Squibb outside the submitted work. Dr Ferreira reported salary from the University of Oxford from the British Heart Foundation during the conduct of the study and grants from GE Healthcare outside the submitted work; in addition, Dr Ferreira had a patent pending research license for WO/2020/161481 to GE Healthcare, a patent for WO/2021/044153 pending research license to GE Healthcare and a patent research license issued for US 11,747,426 B2 to GE Healthcare. Dr Schelbert reported personal fees from Haya Therapeutics outside the submitted work. Dr Clavel reported grants from Edwards Lifesciences, Medtronic, Pi-Cardia, Novartis, and Rednvia outside the submitted work. Dr Gerber reported personal fees from Bristol Myers Squibb and Novartis outside the submitted work. Dr Pibarot reported grants from Edwards Lifesciences Echo Corelab, Medtronic, Pi-Cardia, and Novartis outside the submitted work. Dr Cavalcante reported grants from Abbott Structural, Allina Health Foundation, JenaValve, the National Institutes of Health/National Heart, Lung, and Blood Institute, and honoraria or consultation fees from 4C Medical, Abbott Structural, Alleviant, Anteris, Boston Scientific, Circle Cardiovascular Imaging, Edwards Lifesciences, JenaValve, JC Medical, Medtronic, Novo Nordisk, Pie Medical, Siemens Healthineers, Shockwave, and Zoll outside the submitted work. Dr Moon reported stock holding from MyCardium outside the submitted work. No other disclosures were reported.
그 밖의 정보
- 출판 형태
- Journal Article, Multicenter Study
- 저널
- JAMA cardiology · eISSN 2380-6591
- MeSH
- Humans · Female · Aortic Valve Stenosis* / mortality / surgery / complications · Male · Aged · Sex Factors · Fibrosis · Myocardium* / pathology · Prospective Studies · Prognosis · Magnetic Resonance Imaging, Cine · Middle Aged
- 참고문헌
- 31편