Kostea, A. (Antigone) (2021) Sex differences in remodeling patterns in patients with severe mitral regurgitation. thesis, Medicine.
Full text available on request.Abstract
Introduction Patterns of cardiac remodeling differ between men and women. They are dependent on cardiac morphology and underlying pathology, epigenetics, and hormone response. Whether the same remodeling patterns can be observed in women and men after a percutaneous correction of severe mitral regurgitation (MR) remains unknown. In this study, we aim to compare left ventricular remodeling patterns between women and men 1 year after a percutaneous Mitraclip® intervention. Methods We retrospectively analysed 159 mitral regurgitation patients who were treated with the Mitraclip® implant in the UMCG or the Martini Hospital Groningen, between 2011 and 2020. Patients were excluded if the quality of baseline transthoracic echocardiography (TTE) images was suboptimal. Left ventricular global longitudinal strain (LV GLS) and left atrial (LA) reservoir strain analysis were performed at baseline and at 1-year follow-up. Left ventricular (LV) reverse remodeling was defined as a 15% reduction in LV end-diastolic volume index (LVEDVi). Left atrial (LA) reverse remodelling was defined as a 15% or more reduction in LA end-systolic volume index (LAESVi) at 12-month follow-up. Results The mean patient age was 71.4, 55% of patients were female and 98.3% had severe MR. Before the Mitraclip® procedure patients exhibited moderately dilated LV (LVEDVi: 73.9 ± 29.8) with impaired myocardial contractility (LVEF: 44% ± 14 and LV GLS: -9.8 ± 4.3) and severely dilated LA (LAVi: 57 ± 17). At 1-year follow-up, 92% procedural success was noted and an improvement in the NYHA class (1.3 ± 0.9), as well as the MR grade (1.9 ± 0.8). Men and women had the same grade of LV reverse remodeling (male: 30.8%, female: 30.3%, P = 0.97) and LA reverse remodeling (male: 25%, female: 30.4%, P = 0.68). Male patients had a greater amount of LA improvement in terms of strain (male: 64.3%, female: 42.4%, P = 0.09). A lower baseline LV GLS (odds ratio = 0.84, P = 0.02) and higher baseline LA Reservoir Strain (odds ratio = 0.88, P = 0.005) were associated with a higher chance of left ventricular and left atrial improvement in strain, respectively. Conclusion The Mitraclip® intervention was associated with clinical improvement (NYHA class and MR grade) in both men and women at 1-year follow-up. Left ventricular and left atrial reverse remodeling occurred equally in both sexes, whereas male patients had a greater incidence of LA improvement in strain. Baseline Left Ventricular Global Longitudinal Strain and Left Atrial Reservoir Strain can be thought of as reliable predictors of left ventricular reverse remodeling and left atrial improvement in strain, respectively.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Voors, prof. dr. A. and Melle, dr. J. van and Lipsic, dr. E. |
| Faculty: | Medical Sciences |
| Date Deposited: | 07 Jan 2022 09:03 |
| Last Modified: | 07 Jan 2022 09:03 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2985 |
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