Key result
Higher 3D echocardiography-derived left ventricular end-diastolic volume was associated with increased all-cause mortality (HR 1.20), though this association was present in men but reversed in women.
Why the study?
Three-dimensional echocardiography (3DE) LV measures predict outcomes in high-risk individuals, but their prognostic value and potential sex differences in the general population are unknown.
Do 3D echocardiography measures of LV structure and function predict mortality and cardiovascular morbidity differently in men versus women in a general community population?
Cohort (n=922)
No
Do 3D echocardiography measures of LV structure and function predict mortality and cardiovascular morbidity differently in men versus women in a general community population?
Effect estimate: HR 1.20 (95% CI 1.02-1.42)
p-value: p=0.030
3D echocardiographic measures of LV volume and remodeling predict long-term mortality and cardiovascular events in the general population, but these associations exhibit significant sex differences.
Background: Three-dimensional echocardiography (3DE) measures of the left ventricle (LV) predict outcomes in high risk individuals, but their prognostic value in the general population is unknown. We aimed to establish whether 3DE was associated with mortality and morbidity in a multi-ethnic community-based sample, if associations differed by sex, and explored potential mechanisms explaining sex differences. Methods: 922 individuals (69.7 ± 6.2 years; 717 men) from the SABRE study underwent a health examination including echocardiography. Associations between 3DE LV measures (ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV), LV remodeling index (LVRI) and LV sphericity index (LVSI), and all-cause mortality and a composite cardiovascular endpoint [comprising new onset (non)fatal coronary heart disease, heart failure hospitalization, new-onset arrhythmias and cardiovascular mortality] were determined using multivariable Cox regression over a median follow-up of 8 years (all-cause mortality) and 7 years (composite cardiovascular endpoint). Results: interaction <0.1). In men increased LV volumes and LVSI and decreased LVRI and EF were associated with higher mortality, but associations were null or reversed in women (hazard ratios (95% CI) men vs. women: EDV 1.25 (1.05, 1.48) vs. 0.54 (0.26, 1.10); ESV, 1.36 (1.12, 1.63) vs. 0.59 (0.33, 1.04); LVRI, 0.79 (0.64, 0.96) vs. 1.70 (1.03, 2.80); LVSI, 1.27 (1.05, 1.54) vs. 0.61 (0.32, 1.15); and EF, 0.78 (0.66, 0.93) vs. 1.27 (0.69, 2.33). Similar sex differences were observed for associations with the composite cardiovascular outcome. Adjustment for LV diastolic stiffness and arterial stiffness marginally attenuated these differences. Conclusions: 3DE measures of LV volume and remodeling are associated with all-cause mortality and cardiovascular morbidity; however, some associations differ by sex. Sex-differences in LV remodeling patterns may influence mortality and morbidity risk in the general population.
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Saikhan et al. (2023) conducted a cohort in Cardiovascular morbidity and mortality (n=922). 3D echocardiography (3DE) left ventricular measures was evaluated on All-cause mortality (per SD increase in end-diastolic volume) (HR 1.20, 95% CI 1.02-1.42, p=0.030). Higher 3D echocardiography-derived left ventricular end-diastolic volume was associated with increased all-cause mortality (HR 1.20), though this association was present in men but reversed in women.
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