Functional aortic valve area differs significantly between sexes: A phase-contrast cardiac MRI study in patients with severe aortic stenosis
Background: Aortic stenosis (AS) is one of the most prevalent valvular heart-diseases in Europe. Currently, diagnosis and classification are not sex-sensitive; however, due to a distinctly different natural history of AS, further investigations of sex-differences in AS-patients are needed. Thus, thi...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2024-04-01
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| Series: | International Journal of Cardiology: Heart & Vasculature |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S235290672400023X |
| _version_ | 1827289738119217152 |
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| author | Felix Troger Christian Kremser Mathias Pamminger Sebastian J Reinstadler Gudrun C Thurner Benjamin Henninger Gert Klug Bernhard Metzler Agnes Mayr |
| author_facet | Felix Troger Christian Kremser Mathias Pamminger Sebastian J Reinstadler Gudrun C Thurner Benjamin Henninger Gert Klug Bernhard Metzler Agnes Mayr |
| author_sort | Felix Troger |
| collection | DOAJ |
| description | Background: Aortic stenosis (AS) is one of the most prevalent valvular heart-diseases in Europe. Currently, diagnosis and classification are not sex-sensitive; however, due to a distinctly different natural history of AS, further investigations of sex-differences in AS-patients are needed. Thus, this study aimed to detect sex-differences in severe AS, especially concerning flow-patterns, via phase-contrast cardiac magnetic resonance imaging (PC-CMR). Methods: Forty-four severe AS-patients (20 women, 45 % vs. 24 men, 55 %) with a median age of 72 years underwent transthoracic echocardiography (TTE), cardiac catheterization (CC) and CMR. Aortic valve area (AVA) and stroke volume (SV) were determined in all modalities, with CMR yielding geometrical AVA via cine-planimetry and functional AVA via PC-CMR, the latter being also used to examine flow-properties. Results: Geometrical AVA showed no sex-differences (0.91 cm2, IQR: 0.61–1.14 vs. 0.94 cm2, IQR: 0.77–1.22, p = 0.322). However, functional AVA differed significantly between sexes in all three modalities (TTE: p = 0.044; CC/PC-CMR: p < 0.001). In men, no significant intermethodical biases in functional AVA-measurements between modalities were found (p = 0.278); yet, in women the particular measurements differed significantly (p < 0.001). Momentary flowrate showed sex-differences depending on momentary opening-degree (at 50 %, 75 % and 90 % of peak-AVA, all p < 0.001), with men showing higher flowrates with increasing opening-area. In women, flowrate did not differ between 75 % and 90 % of peak-AVA (p = 0.191). Conclusions: In severe AS-patients, functional AVA showed marked sex-differences in all modalities, whilst geometrical AVA did not differ. Inter-methodical biases were negligible in men, but not in women. Lastly, significant sex-differences in flow-patterns fit in with the different pathogenesis of AS. |
| first_indexed | 2024-03-08T05:13:51Z |
| format | Article |
| id | doaj.art-228b5081066f4f649a5f178c2310a517 |
| institution | Directory Open Access Journal |
| issn | 2352-9067 |
| language | English |
| last_indexed | 2024-04-24T11:56:14Z |
| publishDate | 2024-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Cardiology: Heart & Vasculature |
| spelling | doaj.art-228b5081066f4f649a5f178c2310a5172024-04-09T04:13:12ZengElsevierInternational Journal of Cardiology: Heart & Vasculature2352-90672024-04-0151101357Functional aortic valve area differs significantly between sexes: A phase-contrast cardiac MRI study in patients with severe aortic stenosisFelix Troger0Christian Kremser1Mathias Pamminger2Sebastian J Reinstadler3Gudrun C Thurner4Benjamin Henninger5Gert Klug6Bernhard Metzler7Agnes Mayr8University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35 6020, Innsbruck, AustriaUniversity Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35 6020, Innsbruck, AustriaUniversity Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35 6020, Innsbruck, AustriaUniversity Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35 6020, Innsbruck, AustriaInstitute of Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, Müllerstraße 44 6020, Innsbruck, AustriaUniversity Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35 6020, Innsbruck, AustriaDepartment of Internal Medicine, County Hospital Bruck an der Mur, Tragoesser Strasse 1 8600, Bruck an der Mur, AustriaUniversity Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35 6020, Innsbruck, AustriaUniversity Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35 6020, Innsbruck, Austria; Corresponding author at: University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35 A-6020, Innsbruck, Austria.Background: Aortic stenosis (AS) is one of the most prevalent valvular heart-diseases in Europe. Currently, diagnosis and classification are not sex-sensitive; however, due to a distinctly different natural history of AS, further investigations of sex-differences in AS-patients are needed. Thus, this study aimed to detect sex-differences in severe AS, especially concerning flow-patterns, via phase-contrast cardiac magnetic resonance imaging (PC-CMR). Methods: Forty-four severe AS-patients (20 women, 45 % vs. 24 men, 55 %) with a median age of 72 years underwent transthoracic echocardiography (TTE), cardiac catheterization (CC) and CMR. Aortic valve area (AVA) and stroke volume (SV) were determined in all modalities, with CMR yielding geometrical AVA via cine-planimetry and functional AVA via PC-CMR, the latter being also used to examine flow-properties. Results: Geometrical AVA showed no sex-differences (0.91 cm2, IQR: 0.61–1.14 vs. 0.94 cm2, IQR: 0.77–1.22, p = 0.322). However, functional AVA differed significantly between sexes in all three modalities (TTE: p = 0.044; CC/PC-CMR: p < 0.001). In men, no significant intermethodical biases in functional AVA-measurements between modalities were found (p = 0.278); yet, in women the particular measurements differed significantly (p < 0.001). Momentary flowrate showed sex-differences depending on momentary opening-degree (at 50 %, 75 % and 90 % of peak-AVA, all p < 0.001), with men showing higher flowrates with increasing opening-area. In women, flowrate did not differ between 75 % and 90 % of peak-AVA (p = 0.191). Conclusions: In severe AS-patients, functional AVA showed marked sex-differences in all modalities, whilst geometrical AVA did not differ. Inter-methodical biases were negligible in men, but not in women. Lastly, significant sex-differences in flow-patterns fit in with the different pathogenesis of AS.http://www.sciencedirect.com/science/article/pii/S235290672400023XAortic StenosisCardiovascular MRISex DifferencesPhase-Contrast MRI |
| spellingShingle | Felix Troger Christian Kremser Mathias Pamminger Sebastian J Reinstadler Gudrun C Thurner Benjamin Henninger Gert Klug Bernhard Metzler Agnes Mayr Functional aortic valve area differs significantly between sexes: A phase-contrast cardiac MRI study in patients with severe aortic stenosis International Journal of Cardiology: Heart & Vasculature Aortic Stenosis Cardiovascular MRI Sex Differences Phase-Contrast MRI |
| title | Functional aortic valve area differs significantly between sexes: A phase-contrast cardiac MRI study in patients with severe aortic stenosis |
| title_full | Functional aortic valve area differs significantly between sexes: A phase-contrast cardiac MRI study in patients with severe aortic stenosis |
| title_fullStr | Functional aortic valve area differs significantly between sexes: A phase-contrast cardiac MRI study in patients with severe aortic stenosis |
| title_full_unstemmed | Functional aortic valve area differs significantly between sexes: A phase-contrast cardiac MRI study in patients with severe aortic stenosis |
| title_short | Functional aortic valve area differs significantly between sexes: A phase-contrast cardiac MRI study in patients with severe aortic stenosis |
| title_sort | functional aortic valve area differs significantly between sexes a phase contrast cardiac mri study in patients with severe aortic stenosis |
| topic | Aortic Stenosis Cardiovascular MRI Sex Differences Phase-Contrast MRI |
| url | http://www.sciencedirect.com/science/article/pii/S235290672400023X |
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