Sex-Related Differences in Myocardial Remodeling

Abstract

Sex has a profound impact on myocardial remodeling, which is defined as the molecular and cellular events after an injury to the myocardium (i.e., necrosis, pressure overload, volume overload, and aging) leading to a change in shape, dimension, and function of cardiac chambers. Indeed, experimental studies and post-mortem and observational clinical studies suggest the presence of important differences in myocardial remodeling between females and males in response to different types of injures including aging, pressure and volume overload, and myocardial infarction. Interestingly, the remodeling process appears to be more favorable in women versus men; women are more likely to present heart failure with preserved systolic function and are at greater risk for low output syndrome acutely. These differences between men and women are widely held to be related to sex hormones such as estrogen, although the molecular effects of estrogen on ventricular cardiomyocytes are incompletely understood. In this review, we summarize the evidence supporting these notions and discuss the underlying mechanisms and the clinical implications.

Relationship between Framingham Risk Score and Left Ventricular Remodeling after Successful Primary Percutaneous Coronary Intervention in Patients with First Myocardial Infarction and Single Vessel Disease

“…In our study, women had a more favorable course of LV remodeling following STEMI, which could be related to gender differences in levels of sex hormones [23]. Cavasin et al have demonstrated that estrogen and testosterone play different and opposing roles in the development of heart failure and long-term LV remodeling following MI.…”

Sex‐ and Race‐Related Differences in Characteristics and Outcomes of Hospitalizations for Heart Failure With Preserved Ejection Fraction

“…This confirms sex differences previously observed in the I‐PRESERVE registry,5 and for the first time identifies race‐related differences with regard to outcomes in patients with concurrent HFpEF and atrial fibrillation. Sex‐ and race‐related differences in left ventricular adaptation to stressors have previously been demonstrated, as women40, 41, 42 and blacks43, 44, 45 have a predilection for developing concentric left ventricular hypertrophy and greater diastolic dysfunction compared with men and whites. Whether these differences contribute to an increased vulnerability to atrial fibrillation among women and blacks is not well understood and warrants investigation.…”

The fibrosis marker galectin‐3 and outcome in the general population

“…Prognostic value, however, seems equally strong for male and female subjects, so that gender-specific elevations carry equal prognostic importance. The gender interaction warrants further study, as for instance ventricular remodelling differs considerably between male and female subjects [32], and the role of galectin-3 in this may be of importance.…”