Influence of age and sex on left ventricular remodelling in chronic aortic regurgitation

Aortic regurgitant volumes (RVol) and left ventricular (LV) dimensions and volumes are essential parameters for assessing the severity and guiding surgical timing in aortic regurgitation (AR). However, normal LV volumes vary with age and sex, potentially affecting the interpretation of dilation. This study investigated the impact of sex and age on LV remodelling in chronic AR using cardiac magnetic resonance (CMR).

This monocentric prospective cross-sectional study enrolled 290 consecutive adult patients (mean age 51 ± 16 years, 19% women) with chronic at least moderate AR by echocardiography between 2003 and 2022 to undergo a comprehensive CMR examination for evaluation of AR severity and LV remodelling. The correlation between regurgitant fraction (RF) and RVol was age and sex dependent, as both absolute but also body surface indexed RVol represented a higher RF in women and older patients. Also, women had less dilated ventricles and LV-EDVi and LV-ESVi increased less with increasing AR severity in females and with advancing age. Therefore, LV volumes and RVol underestimated AR severity by RF in such patients. However, women had larger LV diameters and more spherical ventricles. Therefore, LV diameters failed to accurately identify severe AR among females as opposed to males. Comparatively, age- and sex-specific LV volume thresholds could equally assess AR severity across sexes.

Conventional parameters used to grade AR severity and LV remodelling are significantly influenced by age and sex. This encourages the use of age- and sex-specific volumetric thresholds for LV dilation monitoring and surgical referral in AR patients.