Key result
Severe AR triggers adverse events at markedly lower LVESVi thresholds in women and older patients.
Why the study?
Current guidelines for aortic regurgitation recommend the same linear LV dimension for intervention regardless of age and sex, motivating an evaluation of how age and sex affect LV remodeling and clinical outcomes.
Do older age and female sex affect the degree of left ventricular remodeling and the threshold for adverse events in patients with severe aortic regurgitation?
Cohort (n=525)
Do older age and female sex affect the degree of left ventricular remodeling and the threshold for adverse events in patients with severe aortic regurgitation?
Older patients and women with chronic severe aortic regurgitation maintain smaller left ventricular volumes and experience adverse events at lower LVESVi thresholds than younger men, challenging current uniform guideline intervention cutoffs.
Answers are grounded in this paper and cite their sources.
Age and sex influence LV remodeling in severe AR; challenges uniform thresholds and leaves open personalized criteria for prospective validation.
BACKGROUND Current guidelines for aortic regurgitation (AR) recommend the same linear left ventricular (LV) dimension for intervention regardless of age and sex. OBJECTIVES The purpose of this study was to evaluate the impact of age and sex on the degree of LV remodeling and outcomes. METHODS We included consecutive patients with severe AR who were serially monitored by echocardiogram between 2010 and 2016. The 2 main endpoints were as follows: 1) LV end-systolic volume indexed to body surface area (LVESVi) and LV end-diastolic volume indexed to body surface area; and 2) adverse events (AE). We evaluated the longitudinal rate of LV remodeling and determined the association between LV volume and AE by age and sex. RESULTS A total of 525 adult patients (26% women) with a median echocardiogram follow-up of 2.0 years (IQR: 1.0-3.6 years) were included. At baseline, older patients (age ≥60 years) had smaller LV volumes compared with younger patients (age <60 years), eg, the mean LVESVi was 27.3 mL/m2 vs 32.3 mL/m2, respectively. Similarly, women had smaller LV volumes compared with men (mean LVESVi was 23.3 mL/m2 vs 32.4 mL/m2). On serial evaluation, older patients and women maintained smaller LV volumes compared with younger patients and men, respectively. There were 210 (40%) AE during follow-up. The optimal discriminatory threshold for AE varies by age and sex, eg, the LVESVi threshold was highest for young men (50 mL/m2), intermediate for older men (35 mL/m2), and lowest for women (27 mL/m2). CONCLUSIONS On serial evaluation, older patients and women with chronic AR maintained smaller LV volumes than younger patients and men, respectively, and develop AE at lower LV volumes.
No takes yet. Share an insight, caveat, or question.
Akintoye et al. (2023) conducted a cohort in Severe aortic regurgitation (AR) (n=525). Older age (≥60 years) and female sex vs. Younger age (<60 years) and male sex was evaluated on 1) LV end-systolic volume indexed to body surface area (LVESVi) and LV end-diastolic volume indexed to body surface area; and 2) adverse events (AE). Older patients and women with severe AR maintained smaller LV volumes and developed adverse events at lower LVESVi thresholds.
Synapse has enriched 10 related papers. Consider them for comparative context: