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September 8, 2026European Heart Journal - Imaging Methods and PracticeOpen Access

Sex-specific shape models better organize age-associated ventricular variation than pooled models containing ~57% sex-driven variance.

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Why the study?

Although age- and sex-related differences in cardiac anatomy are established using conventional CMR, their representation in three-dimensional ventricular shape remains unclear, and pooled models may obscure within-sex age-associated variation.

Do sex-specific statistical shape models provide a more interpretable representation of age-associated ventricular variation than a sex-agnostic model in asymptomatic adults?

Population

185 male and 187 female asymptomatic Swiss adults aged 18 to 85 years

Comparison

Sex-specific statistical shape models vs sex-agnostic pooled model

Design

Cross-sectional study

Key result

Sex-specific statistical shape models better organized age-associated ventricular variation than a pooled model, in which 57% of first-mode variance was attributable to between-sex differences.

Authors

SBStefano BuosoVVValery L VisserPLPia Leuders

Discussion

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Overview

Sex-specific models may clarify age-related ventricular remodeling by removing sex confounding; hypothesis-generating for refined CMR reference standards.

Key Points

  • To determine whether sex-specific statistical shape models provide a clearer, more interpretable representation of age-associated biventricular variation compared to a pooled, sex-agnostic model.
  • Reconstructed 3D end-diastolic biventricular meshes from cine cardiovascular magnetic resonance (CMR) imaging in a cross-sectional cohort of 372 screened asymptomatic Swiss adults (185 males, 187 females; aged 18 to 85 years).
  • Constructed statistical shape models for the pooled cohort and separately by sex, evaluating shape modes via anatomical visualization, variance decomposition, and correlation with demographic and CMR biomarkers.
  • In the pooled model, the first mode explained 31% of total shape variance, with 57% of that first-mode variance driven strictly by between-sex differences.
  • The first shape mode accounted for 22% of total variance in the male model and 19% in the female model, isolating age-associated variation within each sex rather than splitting it across modes.
  • In males, age associations peaked in the second mode and positively correlated with ventricular volume and mass, whereas in females, age-associated changes localized to the first mode and inversely correlated with volume and mass.

Study Design

Type

Cross-Sectional (n=372)

Structured PICO

Do sex-specific statistical shape models provide a more interpretable representation of age-associated ventricular variation than a sex-agnostic model in asymptomatic adults?

P
Population
372 asymptomatic Swiss adults aged 18 to 85 years evaluated to compare sex-specific versus sex-agnostic statistical shape models of biventricular cardiac anatomy.
E
Exposure
Sex-specific statistical shape models of biventricular anatomy
C
Comparator
Sex-agnostic (pooled) statistical shape model
O
Outcome
Interpretability and representation of age-associated ventricular variationsurrogate

Sex-specific anatomical reference models better capture within-sex cardiac aging structure by removing confounding between-sex anatomical variations seen in pooled models.

Cite This Study

Buoso et al. (2026) conducted a cross-sectional in Asymptomatic (n=372). Sex-specific statistical shape models vs. Sex-agnostic (pooled) statistical shape model was evaluated on Proportion of total shape variance explained by the first mode. Sex-specific statistical shape models better organized age-associated ventricular variation than a pooled model, in which 57% of first-mode variance was attributable to between-sex differences.

synapsesocial.com/papers/6a9fd7ab58e84d0ff5b46939https://doi.org/10.1093/ehjimp/qyag156
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