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

Authors :
Akintoye E
Saijo Y
Braghieri L
Badwan O
Patel H
Dabbagh MM
El Dahdah J
Jellis CL
Desai MY
Rodriguez LL
Grimm RA
Griffin BP
Popović ZB
Source :
Journal of the American College of Cardiology [J Am Coll Cardiol] 2023 Apr 18; Vol. 81 (15), pp. 1474-1487.
Publication Year :
2023

Abstract

Background: Current guidelines for aortic regurgitation (AR) recommend the same linear left ventricular (LV) dimension for intervention regardless of age and sex.<br />Objectives: The purpose of this study was to evaluate the impact of age and sex on the degree of LV remodeling and outcomes.<br />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.<br />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/m <superscript>2</superscript> vs 32.3 mL/m <superscript>2</superscript> , respectively. Similarly, women had smaller LV volumes compared with men (mean LVESVi was 23.3 mL/m <superscript>2</superscript> vs 32.4 mL/m <superscript>2</superscript> ). 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/m <superscript>2</superscript> ), intermediate for older men (35 mL/m <superscript>2</superscript> ), and lowest for women (27 mL/m <superscript>2</superscript> ).<br />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.<br />Competing Interests: Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.<br /> (Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Details

Language :
English
ISSN :
1558-3597
Volume :
81
Issue :
15
Database :
MEDLINE
Journal :
Journal of the American College of Cardiology
Publication Type :
Academic Journal
Accession number :
37045517
Full Text :
https://doi.org/10.1016/j.jacc.2023.02.037