Impact of Age and Sex on Left Ventricular Remodeling in Patients With Aortic Regurgitation

J Am Coll Cardiol. 2023 Apr 18;81(15):1474-1487. doi: 10.1016/j.jacc.2023.02.037.


Background: Current guidelines for aortic regurgitation (AR) recommend the same linear left ventricular (LV) dimension for intervention regardless of age and sex.

Objectives: The purpose of this study was to evaluate the impact of age and sex on the degree of LV remodeling and outcomes.

Methods: We included consecutive patients with severe AR who were serially monitored by echocardiogram between 2010 and 2016. The 2 main endpoints were as follows: 1) LV end-systolic volume indexed to body surface area (LVESVi) and LV end-diastolic volume indexed to body surface area; and 2) adverse events (AE). We evaluated the longitudinal rate of LV remodeling and determined the association between LV volume and AE by age and sex.

Results: A total of 525 adult patients (26% women) with a median echocardiogram follow-up of 2.0 years (IQR: 1.0-3.6 years) were included. At baseline, older patients (age ≥60 years) had smaller LV volumes compared with younger patients (age <60 years), eg, the mean LVESVi was 27.3 mL/m2 vs 32.3 mL/m2, respectively. Similarly, women had smaller LV volumes compared with men (mean LVESVi was 23.3 mL/m2 vs 32.4 mL/m2). On serial evaluation, older patients and women maintained smaller LV volumes compared with younger patients and men, respectively. There were 210 (40%) AE during follow-up. The optimal discriminatory threshold for AE varies by age and sex, eg, the LVESVi threshold was highest for young men (50 mL/m2), intermediate for older men (35 mL/m2), and lowest for women (27 mL/m2).

Conclusions: On serial evaluation, older patients and women with chronic AR maintained smaller LV volumes than younger patients and men, respectively, and develop AE at lower LV volumes.

Keywords: age; aortic regurgitation; remodeling; sex.

MeSH terms

  • Adult
  • Aged
  • Aortic Valve Insufficiency* / diagnostic imaging
  • Echocardiography
  • Female
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Stroke Volume
  • Ventricular Function, Left
  • Ventricular Remodeling