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Prospective Comparison of Temporal Myocardial Function in Men Versus Women After Anterior ST-Elevation Myocardial
Sandeep Jha1, Aaron Shekka Espinosa2, Linnea Molander2
1Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden; Wallenberg Centre for Molecular and Translational Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
Insights
Women show greater cardiac function recovery after ST-elevation myocardial infarction (STEMI) compared to men. This study found improved akinesia recovery, wall motion score index, and ejection fraction in women post-STEMI.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Medical Research
Background:
- Women experience higher morbidity and mortality after ST-elevation myocardial infarction (STEMI).
- Sex differences in cardiac function during acute and subacute STEMI phases remain unclear.
Purpose of the Study:
- To prospectively compare cardiac function changes in women versus men after anterior STEMI with timely reperfusion.
- To analyze sex-based differences in recovery of cardiac function in the acute and subacute phases.
Main Methods:
- Prospective enrollment of 105 men and 41 women in the STAMI study (NCT04448639) with anterior STEMI.
- Serial echocardiography and blood sampling from admission up to 30 days.
- Analysis of akinesia recovery, wall motion score index (WMSI), left ventricular ejection fraction (LVEF), and global longitudinal strain (GLS).
Main Results:
- Women demonstrated significantly greater akinesia recovery (8.3% difference at 30 days) compared to men.
- Higher probabilities for greater akinesia recovery (96.0%) and WMSI improvement (99.0%) in women.
- Trends towards greater improvement in LVEF and GLS were observed in women, though less pronounced.
Conclusions:
- Cardiac dysfunction recovered to a greater extent in women than in men following anterior STEMI with timely reperfusion.
- Findings suggest potential sex-specific differences in myocardial healing and functional recovery post-STEMI.
- Further research into mechanisms underlying these sex differences is warranted.
Abstract:
Compared to men, women have been reported to have increased morbidity and mortality after ST-elevation myocardial infarction (STEMI); but sex differences in cardiac function in the acute and subacute phases of STEMI are incompletely understood. The objective of this study was to prospectively compare changes in cardiac function over the acute and subacute phases after anterior STEMI with timely reperfusion in women versus men. The Stunning in Takotsubo versus Acute Myocardial Infarction (STAMI) study (NCT04448639) prospectively enrolled 105 men and 41 women with anterior STEMI. Echocardiography and blood sampling were performed within 4 hours of admission and at 1, 2, 3, 7, 14, and 30 days after admission. The primary outcome was akinesia recovery, defined as the difference in the percentage of akinesia observed at baseline versus follow-up. Secondary outcomes included wall motion score index (WMSI), left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS). Mixed effects linear regression or zero-inflated tobit models with random intercepts were used to model echocardiographic parameters over time. Baseline patient characteristics were similar in both groups. The difference between women and men in akinesia recovery at 30 days was 8.3% (95% credible interval 0.8%, 15.5%). The covariate-adjusted posterior probability that akinesia recovery and WMSI improvement at 30 days are greater in women than men were 96.0% and 99.0% respectively. Similar but less pronounced trends towards greater improvement in women than men were observed for LVEF and GLS. In conclusion, cardiac dysfunction recovered to a greater extent in women than in men after anterior STEMI with timely reperfusion.
