Sex-based differences in left ventricular remodeling in patients with chronic aortic regurgitation: a multi-modality study

Figures

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  Fig. 1. a Assessment of aortic regurgitation (AR) by transthoracic echocardiogram. A Apical 5-chamber view with Color Doppler demonstrating AR (yellow arrow). B Pulse-wave Doppler within the descending aorta with holodiastolic flow reversal (red arrow). C, D Apical 4-chamber and 2-chamber views (respectively) demonstrating traced left ventricular (LV) end-diastolic volume. b Assessment of AR by cardiovascular magnetic resonance (CMR). A Cine balanced steady-state free precession image demonstrating dephasing consistent with AR (red arrow). B Phase-contrast imaging with contours traced for the ascending (red contour) and descending (green contour) aorta. C Measured anterograde and retrograde flow of the ascending (red line) and descending (green line) aorta with holodiastolic flow reversal in the descending aorta (green arrows). D Measurements obtained from flow analysis

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  Fig. 2. Distribution of left ventricular end-diastolic volume index (LVEDVI) and left ventricular end-systolic volume index (LVESVI) by echocardiography and CMR and severity of aortic regurgitation. Top Row (left to right). LVEDVI by echocardiography to severity of AR measured by CMR derived aortic regurgitant fraction by sex; LVEDVI by CMR to severity of AR measured by CMR derived aortic regurgitant fraction by sex. Bland Altman analysis comparing LVEDVI measured by CMR vs echocardiography by sex. Bottom Row (left to right). LVESVI by echocardiography to severity of AR measured by CMR derived aortic regurgitant fraction by sex; LVESVI by CMR to severity of AR measured by CMR derived aortic regurgitant fraction by sex. Bland Altman analysis comparing LVESVI measured by CMR vs echocardiography by sex. Black line denotes no difference between modalities

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  Fig. 3. Distribution of left ventricular end-diastolic dimension index (LVEDDI) and left ventricular end-systolic dimension index (LVESDI) by echocardiogram and CMR and severity of aortic regurgitation. Top Row (left to right). Comparison of LVEDDI by echocardiography to severity of AR measured by CMR derived aortic regurgitant fraction by sex. Comparison of LVEDDI by CMR to severity of AR measured by CMR derived aortic regurgitant fraction by sex. Bland Altman analysis comparing LVEDDI measured by CMR vs echocardiography by sex. Bottom Row (left to right). Comparison of LVESDI by echocardiography to severity of AR measured by CMR derived aortic regurgitant fraction by sex. Comparison of LVESDI by CMR to severity of AR measured by CMR derived aortic regurgitant fraction by sex. Bland Altman analysis comparing LVESDI measured by CMR vs echocardiography by sex. Black line denotes no difference between modalities

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  Fig. 4. Distribution of left ventricular length by CMR by severity of aortic regurgitation

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  Fig. 5. Distribution of Sphericity Volume Index adjusted to Relative Wall Thickness

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  Fig. 6. a Differences in LV remodeling Phenotypes based on early vs late phase of remodeling. Illustration demonstrates the differences of regional left ventricular dilation as a function of time. b Sex based Differences in LV Remodeling Phenotypes. CMR images demonstrate corresponding sex based differences in LV remodeling with regional left ventricular dilation in the presence of chronic severe AR

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  Fig. 7. Differences in LV diameter measurements: CMR vs echocardiography. Examples of a male and female patients with severe AR and severe LV dilation to illustrate multiple etiologies for discrepant LV diameter measurements in women. Blue arrow denotes prominent trabeculations in the basal inferolateral wall. Dotted blue line denotes imaging plane that was prescribed to obtain the CMR LV outflow tract/3chamber cine image