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Heartbeat: sex-specific cardiac microstructural changes in patients with heart failure
  1. Catherine M Otto
  1. Division of Cardiology, University of Washington, Seattle, Washington, USA
  1. Correspondence to Professor Catherine M Otto, Division of Cardiology, University of Washington, Seattle, WA 98195, USA; cmotto{at}

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Imaging evaluation of heart failure (HF) risk currently relies on measurement of macrostructural abnormalities, such as chamber volumes, wall thickness and function which may lead to underestimation of HF risk in women. Sex-specific responses to stressors at the cellular/microstructural and microvascular level suggest that early detection of microstructural alterations might improve HF risk prediction in women. To test this hypothesis, Kwan and colleagues1 measured echocardiographic myocardial microstructural changes (figure 1) in 2511 adults with no cardiovascular disease (CVD) at baseline in the Framingham Offspring Study (mean age 66 years, 56% women). Over 7.4±1.7 years follow-up, baseline myocardial microstructural changes were associated with an increased risk of incidence HF in women (but not in men) even after correction for other traditional risk factors and relative wall thickness (HR 1.47, p=0.02).

Figure 1

Traditional frameworks of heart failure (HF) stages may insufficiently capture early microstructural alterations that can reveal sex-specific features of HF risk. Therefore, as part of an a priori sex-based analytical framework, we used the high-spectrum signal intensity coefficient (HS-SIC) to identify microstructural alterations and examine their potential sex-specific associations with incident HF. The HS-SIC, a measure previously related to myocardial fibrosis, is calculated using a B-mode parasternal long axis (PLAX) view, with a region-of-interest (ROI) placed at the myocardial–pericardial interface at the level of the mitral leaflet tips. The ROI is analytically processed to provide a distribution of signal intensities, with the HS-SIC calculated as the sum of 1 − the normalised intensity. Higher HS-SIC levels are associated with increased myocardial fibrosis.

In the accompanying editorial, Belzile and Sénéchal …

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.