Sex differences in cardiac structure and function following ST-segment elevation myocardial infarction

Abstract Post-STEMI cardiac remodelling represents an important determinant of long-term outcomes, yet sex-specific differences in this process remain poorly understood. While disparities between women and men are well-established in the presentation, treatment, and outcomes of both STEMI and heart failure, the extent to which cardiac structure and function evolve differently between the sexes following a myocardial infarction has received limited attention. This study investigated sex-based differences in cardiac remodelling among patients enrolled in the GIPS-III trial, a randomized controlled trial comparing metformin to placebo in STEMI patients without diabetes. Transthoracic echocardiography was performed during the initial hospitalization and repeated at four months, allowing for a detailed assessment of structural and functional changes over time. The analysis included 379 patients, of whom 95 were women and 284 were men. Women presented with a higher prevalence of hypertension, lower hemoglobin levels, and markedly elevated NT-proBNP concentrations both on admission and at 24 hours. At both time points, women demonstrated smaller left ventricular diameters and volumes, a higher E/e’ ratio, and a greater left ventricular ejection fraction compared to men. Despite these baseline differences, the trajectories of echocardiographic parameters over time did not differ meaningfully between sexes. Adverse left ventricular remodelling, defined as a 20% or greater increase in left ventricular end-diastolic volume, occurred at comparable rates in women and men. Left ventricular geometry at four months, encompassing normal geometry, concentric or eccentric hypertrophy, and concentric remodelling, was similarly distributed across sexes. These findings suggest that while women and men differ in their baseline cardiac characteristics following STEMI, the underlying remodelling process appears to follow a broadly similar course, which has relevant implications for how post-STEMI monitoring and management strategies might be applied across sexes.