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Rapid Fire Abstracts

Rapid Fire 06- Valvular Heart Disease II

Sex differences in myocardial perfusion improvements after aortic valve replacement for severe symptomatic aortic stenosis (RF_FR_357)

Friday, January 31, 2025
11:20 AM – 11:30 AM East Coast USA Time
Location: Blue Room PreFunction
Background:

Biological sex impacts the myocardial remodeling and clinical outcomes in aortic stenosis (AS). Impaired myocardial perfusion is an independent predictor of adverse cardiovascular events in AS. Varying patterns of ventricular remodeling in AS may cause varying myocardial perfusion effects and symptoms. This work aimed to determine sex differences in myocardial perfusion in severe AS without obstructive coronary artery disease (CAD) pre-AVR and its recovery post-AVR.



Methods:

This was a prospective single-center longitudinal cohort study with recruitment from April-2019 to November-2023, in a tertiary cardiovascular center. Patients with severe symptomatic AS (n=202, 70 women) undergoing AVR were recruited, alongside healthy controls (n=39, 18 women). Participants underwent cardiovascular magnetic resonance (CMR) 1-month before (n=202) and 6-months post-AVR (n=162). Significant obstructive CAD was excluded in all AS patients by coronary angiography. 



 



Main outcomes: The sex-specific differences in myocardial perfusion recovery (rest and adenosine stress myocardial blood flow [MBF], myocardial perfusion reserve [MPR], endocardial to epicardial [Endo:Epi] MBF ratio) with AVR. 




 


Results:

Patients were matched in age (combined age:73[72,76] years), AS severity and comorbidities. While women had higher surgical risk scores (Society of Thoracic Surgeons Score 1.66[1.15,3.27] vs 0.98[0.71,1.44], P<0.0001), the study overall consisted of low-surgical risk participants. 





Pre-AVR, women exhibited higher global-stress-MBF (1.37[1.18-1.75] vs 1.32[1.24-1.41]ml/min/g; P=0.0139) and rest-MBF (0.78[0.74-0.83] vs 0.64[0.54-0.72]ml/min/g, P<0.0001) compared to men, but no difference in MPR.




Post-AVR, both sexes experienced similar relative increments in global-stress-MBF (22[6-38]% vs 25[14-36]%; P=0.127) and MPR (26[11-40] vs 26[15-37]%,P=0.96), and a non-significant reduction in rest-MBF. However, global-stress-MBF (1.93[1.71-2.15] vs 1.62[1.50-1.74]ml/min/g; P=0.0064) and rest-MBF (0.75[0.69-0.80] vs 0.60[0.52-0.70]ml/min/g; P<0.0001) remained higher in women with no difference in post-AVR MPR between the sexes (2.51[2.32-2.70] vs 2.50[2.31-2.69]; P=0.93).




While pre-AVR rest or stress Endo:Epi MBF ratios were not significantly different between the sexes, post-AVR only men showed significant increase in both rest (1.03[1.01-1.04] to 1.09[1.07-1.10];P<0.0001) and stress (0.81[0.78-0.85] to 0.89[0.86-0.92];P<0.0001) Endo:Epi MBF ratios.



 


 


 


Conclusion:

In patients with severe AS without obstructive CAD, there is a persistent impact of biological sex on global myocardial perfusion both before and after AVR. However, with AVR both sexes show similar rates of relative improvements in global stress-MBF and MPR, and a decrease in global rest-MBF with AVR, while only men exhibit a significant change in transmyocardial MBF ratios.