Original InvestigationImpact of Age and Sex on Left Ventricular Remodeling in Patients With Aortic Regurgitation
Central Illustration
Section snippets
Study population
The study cohort consisted of patients on routine surveillance for chronic AR with serial echocardiograms at the Cleveland Clinic (Supplemental Figure 1). We included consecutive patients of at least 21 years of age with moderate to severe AR or severe AR and LV ejection fraction ≥50% who underwent echocardiographic studies between 2010 and 2016 at baseline and at least 1 follow-up study that is ≥6 months from the baseline. Patients aged <21 years were excluded to limit the inclusion of
Results
The study included 525 patients with 1,687 echocardiograms showing moderate to severe or severe AR over a median follow-up of 2.0 years (IQR: 1.0-3.6 years). At baseline examination, the mean age was 55.9 ± 15.7 years, and 25.7% were women. The patients were either asymptomatic (74.7%) or with only minimal symptoms (25.3%) (stage C valvular heart disease). The most common etiology of AR was bicuspid AV (26.7%), and this occurred predominantly among the younger cohort (37.7%) and men (33.6%).
Discussion
In this cohort of patients with moderate to severe or severe AR and preserved LV systolic function, we showed that despite indexing to BSA, LV volumes were smaller in older compared with younger patients, and in women compared with men. These differences in LV volumes persist on serial assessment over time. In addition, LV volumetric assessment was a better prognostic parameter than linear dimension. The optimal discriminatory volume thresholds above which the rate of adverse events
Conclusions
Independent of BSA, older patients and women with significant AR maintain smaller LV volumes than younger patients and men, respectively, on serial evaluation. In addition, they have lower LV volume thresholds above which the rate of adverse events significantly increases. Our results suggest that the use of a singular LV threshold for intervention may lead to delayed referral and disproportionately worse outcomes in older patients and women. Hence, age-specific and sex-specific LV volume
Funding Support and Author Disclosures
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
References (31)
- et al.
Sex-related differences in myocardial remodeling
J Am Coll Cardiol
(2010) - et al.
Long-term outcomes in patients with aortic regurgitation and preserved left ventricular ejection fraction
J Am Coll Cardiol
(2016) - et al.
Outcomes in chronic hemodynamically significant aortic regurgitation and limitations of current guidelines
J Am Coll Cardiol
(2019) - et al.
2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines
J Am Coll Cardiol
(2021) - et al.
ACC/AHA guidelines for the management of patients with valvular heart disease
J Am Coll Cardiol
(1998) - et al.
Predictors of outcome for aortic valve replacement in patients with aortic regurgitation and left ventricular dysfunction: a change in the measuring stick
J Am Coll Cardiol
(1987) - et al.
Chronic aortic regurgitation: prognostic value of left ventricular end-systolic dimension and end-diastolic radius/thickness ratio
J Am Coll Cardiol
(1983) - et al.
Determinants of prognosis of patients with aortic regurgitation who undergo aortic valve replacement
J Am Coll Cardiol
(1984) - et al.
Quantitative echocardiographic determinants of clinical outcome in asymptomatic patients with aortic regurgitation: a prospective study
J Am Coll Cardiol Img
(2008) - et al.
Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance
J Am Soc Echocardiogr
(2017)
Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging
J Am Soc Echocardiogr
Gender differences and aging: effects on the human heart
J Am Coll Cardiol
Gender differences in cardiac remodeling secondary to chronic volume overload
J Card Fail
Sex-based differences in left ventricular remodeling in patients with chronic aortic regurgitation: a multi-modality study
J Cardiovasc Magn Reson
Cardiac myocytes and fibroblasts contain functional estrogen receptors
FEBS Lett
Cited by (0)
Listen to this manuscript's audio summary by Editor-in-Chief Dr Valentin Fuster on www.jacc.org/journal/jacc.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the Author Center.