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

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature Pub Date : 2025-09-30 DOI:10.1016/j.ijcha.2025.101814

Paul C. Onyeji , Shivank Dani , Sonise Momplaisir-Onyeji , Miguel C. Lenzi , Paweł Łajczak , Felipe S. Passos , Leo Consoli , Hristo Kirov , Torsten Doenst , Tulio Caldonazo

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引用次数: 0

Abstract

Background

Aortic stenosis (AS) leads to pathological myocardial remodeling, particularly fibrosis, which contributes to adverse outcomes including heart failure, arrhythmias, and mortality. Evidence suggests sex-specific differences in fibrotic response, but individual studies are underpowered for definitive conclusions. This meta-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

This meta-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.

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主动脉瓣狭窄患者心肌纤维化的性别差异：一项系统回顾和荟萃分析

主动脉狭窄（AS）导致病理性心肌重构，尤其是纤维化，导致心衰、心律失常和死亡等不良后果。证据表明，纤维化反应存在性别特异性差异，但个体研究不足以得出明确结论。本荟萃分析旨在利用心脏磁共振（CMR）参数评估心肌纤维化的性别相关差异。方法检索三个数据库，比较报告cmr衍生测量的男性和女性AS患者的研究。主要结局是晚期钆增强（LGE%）、梗死相关和非梗死相关LGE、细胞外体积（ECV）和间隔E/ E’。使用随机效应模型，用二元结果的风险比（RR）和连续结果的平均差异（MD）表示效应量，每个结果都有95%的置信区间（CI）。使用纽卡斯尔-渥太华量表评估研究质量，并使用GRADE框架对证据的确定性进行评分。结果纳入7项研究（n = 2105，男性1246）。LGE% （MD = 0.13; 95% CI = - 0.93 ~ 1.18; p = 0.770）和梗死相关LGE的风险在两性间无显著差异（RR = 1.61; 95% CI = 0.90 ~ 2.89; p = 0.080）。男性发生非梗死性LGE的风险较高（RR 1.51; 95% CI 1.34 ~ 1.70; p = 0.002）。两性间ECV （MD - 0.45, 95% CI - 2.34 ~ 1.44, p = 0.506）和鼻中隔E/ E′无显著差异（MD - 1.87, 95% CI - 4.05 ~ 0.32, p = 0.072）。这项荟萃分析显示了AS患者心肌纤维化的性别差异，男性表现出更多的局灶性替代纤维化，而女性倾向于弥漫性间质纤维化。这些模式突出了将性别特异性因素纳入诊断和管理的相关性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

IJC Heart and Vasculature Medicine-Cardiology and Cardiovascular Medicine

CiteScore

4.90

自引率

10.30%

发文量

216

审稿时长

56 days

期刊介绍： IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.