Sex, age affect LV remodeling in patients with aortic regurgitation

Older patients and women with chronic aortic regurgitation (AR) present with smaller left ventricular (LV) volumes than do younger patients and men, and they also develop adverse events (AEs) at lower LV volumes, reports a study.

A group of researchers evaluated 525 consecutive patients with severe AR, who were serially monitored by echocardiogram between 2010 and 2016. They then assessed two main endpoints, namely (1) LV end-systolic volume indexed to body surface area (LVESVi) and LV end-diastolic volume indexed to body surface area, and (2) AEs.

In addition, the research team examined the longitudinal rate of LV remodeling and assessed the relationship between LV volume and AE by age and sex.

Of the patients, 26 percent were women. At baseline, older patients (aged ≥60 years) had smaller LV volumes relative to their younger counterparts (aged <60 years); for instance, the mean LVESVi was 27.3 mL/m² in older patients compared with 32.3 mL/m² in younger ones. Likewise, women had smaller LV volumes than men (mean LVESVi: 23.3 vs 32.4 mL/m²).

Serial evaluation revealed that older patients and women maintained smaller LV volumes relative to younger patients and men, respectively.

During follow-up, 210 (40 percent) AEs were reported. The optimal discriminatory threshold for AE varied by age and sex. For instance, young men had the highest LVESVi threshold (50 mL/m²), older men had intermediate (35 mL/m²), and women had the lowest (27 mL/m²).

“Current guidelines for AR recommend the same linear LV dimension for intervention regardless of age and sex,” the researchers said.