The phenomenon of sex differences exists in patients who have abdominal aortic aneurysms (AAA). The occurrence rate of AAA is higher in male, while the rates of rupture and postoperative mortality are higher for female. This phenomenon of sex differences would affect the diagnosis, treatment and postoperative rehabilitation for AAA patients. This article reviewed the recent research status of sex differences on AAA, and explored the phenomenon of sex differences from the aspects of threshold determination, biomechanics and mechanobiology. This review points out that the sex differences on AAA could ascribe to the differences of biomechanical environment and biological properties induced by the vascular size, anatomy structure and structure components of abdominal aortic artery. The comprehensive investigations of the sex differences on AAA could help to optimize the diagnosis, treatment and device design, patient care and rehabilitation strategy of AAA based on sex differences phenomenon.
ObjectiveTo investigate the sex-specific impact of baseline myocardial injury on cardiac reverse remodeling after transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis (AS). MethodsThis retrospective cohort study consecutively enrolled patients with symptomatic severe AS who underwent TAVR between May 2021 and January 2024 at the Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University. According to the "Fourth Universal Definition of Myocardial Infarction (2018)", patients were classified into preprocedural myocardial injury-positive [hs-cTnI(+)] and -negative [hs-cTnI(?)] groups based on high-sensitivity cardiac troponin I (hs-cTnI) levels. Echocardiographic parameters were collected at baseline and at 1, 6, and 12 months after TAVR. Left ventricular mass index (LVMi) was used to evaluate the degree of cardiac reverse remodeling. Stratified by sex, the trends of LVMi at each postoperative timepoint were compared between sexes, and the impact of baseline myocardial injury on cardiac reverse remodeling within 12 months after TAVR was analyzed. ResultsA total of 408 patients were enrolled, with a median age of 72 (67, 77) years, including 227 (55.6%) males and 181 (44.4%) females. Preprocedural severe cardiac remodeling was observed in 81 patients, including 48 (21.1%, 48/227) male and 33 (18.2%, 33/181) female patients. Cardiac reverse remodeling in male patients occurred predominantly within the first 6 months after TAVR and subsequently plateaued between 6 and 12 months (P=0.528), whereas female patients showed continuous improvement in LVMi at each follow-up timepoint throughout the 12-month follow-up (P<0.05). There were 118 (52.0%) male and 100 (55.2%) female patients in the hs-cTnI (+) group. In both male and female subgroups, LVMi in the hs-cTnI (+) group was significantly higher than that in the hs-cTnI (?) group at baseline and each follow-up timepoint (P<0.05). ConclusionThe impact of baseline myocardial injury on post-TAVR cardiac reverse remodeling exhibits sex differences. Male patients in the hs-cTnI (+) group show poorer improvement in cardiac reverse remodeling, with a plateau phase at 6 months postoperatively, while female patients demonstrate sustained improvement in reverse remodeling within 12 months after TAVR.