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Sex-Specific Left Ventricular and Aorta Size Cut-Off Values for Hemodynamically Significant Chronic Aortic

Kuan-Yu Lai1, Masashi Amano2, Yosuke Nabeshima3

  • 1Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital.

Circulation Journal : Official Journal of the Japanese Circulation Society
|May 29, 2024
PubMed

Insights

This study found women with aortic regurgitation (AR) had worse outcomes and received less aortic valve surgery (AVS). Sex-specific criteria for AR intervention may improve survival in women.

Area of Science:

  • Cardiology
  • Cardiovascular Research
  • Medical Science

Background:

  • Current guidelines for chronic aortic regurgitation (AR) lack sex-specific recommendations.
  • This study addresses the need for sex-specific treatment criteria in AR management.
  • Asian AR cohort data was analyzed to identify sex-specific differences.

Purpose of the Study:

  • To examine sex-specific differences in chronic aortic regurgitation (AR).
  • To propose sex-specific treatment criteria for AR based on an Asian cohort.
  • To evaluate the impact of sex on AR progression and outcomes.

Main Methods:

  • Retrospective analysis of 1,305 patients with moderate-severe AR or greater from Taiwan and Japan (2008-2022).
  • Endpoints included aortic valve surgery (AVS), all-cause death (ACD), and cardiovascular death (CVD).
  • Comparison of clinical characteristics, echocardiographic parameters, and survival between men and women.

Main Results:

  • Women with AR were older, more symptomatic, and had larger indexed aorta size (iAortamax) and indexed left ventricular (LV) end-systolic dimension (LVESDi).
  • Women received significantly fewer AVS procedures compared to men.
  • While overall survival was better in men, post-AVS survival and LV remodeling progression were similar between sexes.
  • Multivariable analysis identified age, symptoms, iAortamax, LV ejection fraction (LVEF), LVESDi, LV end-systolic volume index (LVESVi), and ethnicity as determinants of mortality, but not female sex.

Conclusions:

  • Sex-specific cut-off values for key echocardiographic parameters (LVEF, LVESDi, LVESVi, iAortamax) were identified for predicting adverse outcomes.
  • Early detection and intervention using these sex-specific criteria may improve survival in women with AR.
  • The findings support the development of tailored management strategies for AR based on sex.
Abstract

Keywords:
Aortic regurgitationOutcomeSex differences

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