Rapid Fire Abstracts
Diane Rizkallah, MD
Research Fellow
Cleveland Clinic Foundation
Diane Rizkallah, MD
Research Fellow
Cleveland Clinic Foundation
Theerawat Korkerdsup, MD
Advance imaging cardiologist
Bangpakok 9 International Hospital , Thailand
Tom Kai Ming Wang, MBChB MD
Cardiologist
Cleveland Clinic
Carl Ammoury, MD
Research Fellow
Cleveland Clinic Foundation
Kashyap Bodi, MD
Research Fellow
Cleveland Clinic, Cleveland, OH, United States
David Chen, PhD
Director of Artificial Intelligence
Cleveland Clinic
Wilson Tang, MD
Cardiologist
Cleveland Clinic
Christopher Nguyen, PhD, FSCMR, FACC
Director, Cardiovascular Innovation Research Center
Cleveland Clinic
Deborah Kwon, MD, FSCMR
Director of Cardiac MRI
Cleveland Clinic
Sex-based differences in cardiac remodeling have become increasingly more recognized within different cardiac and valvular disease conditions[1,2]. However, differential impact of sex on remodeling/function based on the underlying myopathic phenotype and resultant impact on prognosis is currently unknown. We hypothesized that sex difference in cardiac remodeling in response to functional mitral regurgitation (FMR) differs in nonischemic vs ischemic cardiomyopathy (NICM vs ICM) phenotypes, with resultant differences in prognostic implications.
Methods: We conducted a retrospective study of ICM and NICM patients undergoing CMR between 2001 and 2017. Mitral regurgitation fraction (MRF) was quantified by indirect quantitative method by CMR. Sex based differences in left ventricular end-diastolic volume index (LVEDVi), LV ejection fraction (LVEF), left atrial volume index (LAVi), LA ejection fraction (LAEF), right ventricular ejection fraction (RVEF) and late gadolinium enhancement (LGE) were evaluated in the presence of increasing functional mitral regurgitation (FMR) severity. A multivariable analysis was developed adjusting CMR parameters with clinical risk factors based on the Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) score[3,4].
Results: There were 782 ICM patients ICM and 674 NICM patients in our study, with the following characteristics: 31.8% female, mean age 58±14 years, LVEDVi 131±45.0 mL/m2, LVEF 30±11%, LAEF 43±13%, RVEF 38±17%, LGE 19±17% and mitral regurgitant fraction 15±15%. Notable sex-based differences are as follows:1)while females with ICM demonstrated consistently lower mean left ventricular volumes compared to males, female NICM patients demonstrated significantly steeper increase in LVEDVi with increasing FMR severity compared to males (p=0.026 for the sex interaction); 2)males with ICM demonstrated lower scar burden than females (p=0.043), and demonstrated a more gradual decrease in RVEF with increasing MRF (p=0.044 for the sex interaction); 3)while there are no differences in LAVi between males and females, females maintained a higher LAEF with increasing MRF (p=0.001), see figure 1. On multivariate survival analysis, novel sex interactions emerged: sex X LVEDVi and sex X RVEF with a maximum likelihood estimation of 0.0077 (p=0.003) and 0.016 (p=0.023) respectively, see figure 2A. Risk associated with increasing LVEDVi and declining RVEF was markedly increased in women, compared to men, see figure 2B and figure 3.
Conclusion: Underlying myopathic phenotypes are associated with distinct sex differences in cardiac remodeling/function and are associated with differential risk stratification. Multivariate survival revealed sex-interactions with LVEDVi and RVEF. Further studies are needed to determine the impact of sex-specific criteria for therapeutic interventions to mitigate sex differences in outcomes.
