GENDER DIFFERENCES OF THE ATRIA REMODELLING AND INTRAMURAL INNERVATION IN STRUCTURAL DISEASES OF THE HEART

Aim. To perform the comparative analysis of atria morphometry and histological composition of myocardium in men and women with structural pathology of the heart.

Material and methods. As the materials, case histories were used and autopsy records of 41 patient, age 43 to 88 y.o., 23 males and 18 females; of those 28 had coronary heart disease, 10 — other cardiovascular disorders, 3 — non-cardiac pathology. Organometry was done of the atria in 23 zones. Paraffin slices of all 23 localizations, as of the sinus and atrio-ventricular nodes were colored with hematoxiline and eosine, and by van Hison. Morphometry was done, with assessment of ganglia and nervous fibers localization density, relative square of fibrosis and lipomatosis areas, mean relative square or antigens expression areas in ganglia and nervous fibers. Comparison was done, of morphometric and clinical parameters in men and women.

Results. In men, there was statistically significantly higher mean cardiac mass, distance between inferior pulmonary veins, thickness of the left atrial wall, the cuff height of inferior right pulmonary vein (p<0,05). It was also noted that men and women have difference in the spread of fibrosis and fatty tissue in different atrial areas. Maximal density of ganglia in men was at the ostium of coronary sinus and between inferior pulmonary veins, and in women — between superior and inferior pulmonary veins.

Conclusion. Morphometry showed that remodelling of the atria in cardiovascular diseases has its gender differences, including the diversity of nervous fibers localization in various zones. Further in-depth study of cardiac innervation might help to elaborate different approaches to surgical tactics of the heart diseases in men and women.

1. Regitz-Zagrosek V. Gender and cardiovascular diseases: Why we need gender medicine. Internist (Berl). 2017 Mar 13. DOI: 10.1007/s00108-017-0214-3.

2. Moran G, Pietrokovski S. The landscape of sex-differential transcriptome and its consequent selection in human adults. BMC Biol. 2017; 15: 7. DOI: 10.1186/s12915-017-0352-z.

3. Modena MG, Pettorelli D, Lauria G, et al. Gender Differences in Post-Traumatic Stress. Biores Open Access. 2017 Feb 1; 6 (1): 7-14. DOI: 10.1089/biores.2017.0004.

4. Huang SC, Wong AM, Ho CW, et al. Comparison of cardiac autonomic nervous system disturbed by sleep deprivation in sex and menstrual phase. Chin J Physiol. 2015 Apr 30; 58 (2): 114-23. DOI: 10.4077/CJP.2015.BAD287.

5. Proietti M, Raparelli V, Basili. Relation of female sex to left atrial diameter and cardiovascular death in atrial fibrillation: The AFFIRM Trial. Int J Cardiol. 2016 Mar 15; 207: 258-63. DOI: 10.1016/j.ijcard.2016.01.169.

6. Chapa DW, Akintade B, Thomas SA, Friedmann E. Gender differences in stroke, mortality, and hospitalization among patients with atrial fibrillation: A systematic review. Heart Lung. 2015 May-Jun; 44 (3): 189-98. DOI: 10.1016/j.hrtlng.2015.01.008.

7. Patsyuk AV, Abramov ML, Lebedev DS, Mikhaylov EN. Gender aspects in catheter ablation of atrial fibrillation: a prospective study of efficacy, safety of the procedure and quality of life of the patients. Translational Medicine. 2016; 3 (3): 34-41. (In Russ.) Пацюк А.В., Абрамов М.Л., Лебедев Д.С., Михайлов Е.Н. Гендерные особенности интервенционного лечения фибрилляции предсердий: проспективное исследование эффективности, безопасности вмешательства и качества жизни пациентов. Трансляционная медицина. 2016; 3(3): 34-41 DOI: 10.18705/2311-4495-2016-3-3-34-41.

8. Jones PP, Snitker S, Skinner JS, Gender differences in muscle sympathetic nerve activity: Effect of body fat distribution. Am J Physiol 1996; 270: E363-E366.

9. Michelena HI, Powell BD, Brady PA. Gender in atrial fibrillation: Ten years later. Gend Med. 2010; 7 (3): 206-17. DOI: 10.1016/j.genm.2010.06.001.

10. Brembilla-Perrot B, Huttin O, Manenti V. Sex-related differences in periand post-ablation clinical data for patients with atrial flutter Intern J. of Cardiol. 2013; 168: 1951-54. DOI: 10.1016/j.ijcard.2012.12.088.

11. Santangeli P, Di Biase L, Pelargonio G, Natale A. Outcome of Invasive Electrophysiological Procedures and Gender: Are Males and Females the Same? J of Cardiovasc Electrophysiology. 2011; 22 (5): 605-612. DOI: 10.1111/j.1540-8167.2010.01920.x.

12. Mikhaylov EN, Lebedev DS, Pokushalov EA, et al. Outcomes of cryoballoon in highand low-volume atrial fibrillation ablation centres: a Russian pilot survey. BioMed Research International. 2015. Т. 2015. DOI: 10.1155/2015/591603.

13. Li Z, Wang Z, Yin Z, Zhang Y, et al. Gender differences in fibrosis remodeling in patients with long-standing persistent atrial fibrillation. Oncotarget. 2017 Mar 17. DOI: 10.18632/oncotarget.16342.

14. Chow LTC, Chow SSM, Anderson RH. Autonomic Innervation of the Human Cardiac Conduction System:Changes from Infancy to Senility — an Immunohistochemical and Histochemical Analysis. Anatomical Record 2001; 264: 169-82.