Valvular & structural heart disease
Sex-Specific Association of Myocardial Fibrosis With Mortality in Patients With Aortic Stenosis
Authors' conclusion
In this study, patients with severe AS who underwent AVR exhibited similar ECV% between sexes, while women had lower LGE. Increased myocardial fibrosis provided important prognostic value for both sexes.
Study context
- Population
- Patients with severe aortic stenosis (AS) undergoing cardiovascular magnetic resonance (CMR) before surgical or transcatheter aortic valve replacement (AVR), 2011–2021; main analysis without obstructive coronary artery disease (CAD)670 without obstructive CAD
- Participants
- 822 patients
- Exposure
- Myocardial fibrosis and post-AVR mortality, women vs men
- Womenn = 302
- Menn = 368
- Outcome
- Post-AVR all-cause mortality
- Follow-up
- Median 3.7 (IQR, 2.1-4.7) years
Methodological detailsmulticentre, 13 international sites
- Multicentre
- 13 international sites
Main finding
As reported in the abstract
All-cause mortality by myocardial fibrosis, by sex (no obstructive CAD) · median 3.7 years
Adjusted hazard ratio (95% CI)P value
Womenper 1% ECV% increase
1.08(1.04–1.12)
P < 0.001Menper 1% ECV% increase
1.01(0.96–1.06)
P = 0.66Womenpresence of LGE
2.49(1.07–5.80)
P = 0.03Menpresence of LGE
1.82(1.00–3.32)
P = 0.04Per 1% ECV% increase, as printed
- Deaths in patients without obstructive CAD
- 76 (11.3%)
Observational data: associations, not effects.
Secondary outcomes
CV mortality
- Adjudicated CV deaths
- 29
- Increasing ECV% and late gadolinium enhancement (LGE) associated with higher all-cause and CV mortality in both sexes
Fibrosis by sex
- ECV% similar between sexes; women had less LGE (infarct and noninfarct)
Mortality by noninfarct and infarct-related LGE (entire population)
- Both associated with increased mortality without significant interaction by sex
- n = 822
Original publication
Sex-Specific Association of Myocardial Fibrosis With Mortality in Patients With Aortic Stenosis. JAMA Cardiol. Published 1 May 2025. doi:10.
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