In aortic stenosis, cardiac remodelling and reverse remodelling after aortic valve replacement significantly differ in male and female patients. In a very interesting paper recently published in the
Journal of the American College of Cardiology: Cardiovascular Imaging [
20], the authors demonstrated that, for the same amount of valve stenosis, there were major sex differences in CMR-assessed myocardial remodelling, fibrosis and resultant left ventricle function. Men predominantly had concentric or eccentric left ventricular hypertrophy, a lower LVEF and more fibrosis, whereas women exhibited a more favourable phenotype with less hypertrophy and fibrosis and a higher LVEF. These gender differences in remodelling patterns had been previously demonstrated [
21], with a superior reverse remodelling in men 6 months after aortic valve replacement as a result of their more adverse remodelling at baseline. The causes of this gender dimorphism in myocardial response are incompletely understood but cellular, molecular and neurohormonal mechanisms have been proposed, including differences in profibrotic and inflammatory pathways, as well as differential expression of androgen and oestrogen receptors. Gender differences in the rennin-angiotensin system, nitric oxide activity and norepinephrine release may also contribute to remodelling differences [
22]. These gender-related remodelling differences associated with aortic stenosis might raise the question of sex-specific threshold for aortic valve replacement.