Sex-Specific Left Ventricular and Aorta Size Cut-Off Values for Hemodynamically Significant Chronic Aortic Regurgitation - Implications for Treatment in Asian Populations.
Journal
Circulation journal : official journal of the Japanese Circulation Society
Journal Volume
88
Journal Issue
12
ISSN
1347-4820
Date Issued
2024-11-25
Author(s)
Lai, Kuan-Yu
Amano, Masashi
Nabeshima, Yosuke
Su, Chin-Hua
Liu, Kang
Kitano, Tetsuji
Enriquez-Sarano, Maurice
Takeuchi, Masaaki
Izumi, Chisato
Abstract
There are no sex-specific guidelines for chronic aortic regurgitation (AR). This retrospective study examined sex-specific differences and propose treatment criteria from an Asian AR cohort.
Consecutive 1,305 patients with moderate-severe AR or greater at 3 tertiary centers in Taiwan and Japan (2008-2022) were identified. Study endpoints were aortic valve surgery (AVS), all-cause death (ACD), and cardiovascular death (CVD). The median follow up was 3.9 years (interquartile range 1.3-7.1 years). Compared with men (n=968), women (n=337) were older, had more advanced symptoms, more comorbidities, larger indexed aorta size (iAorta) and indexed left ventricular (LV) end-systolic dimension (LVESDi; P<0.001 for all). Symptomatic status was poorly correlated with the degree of LV remodeling in women (P≥0.18). Women received fewer AVS (P≤0.001) and men had better overall 10-year survival (P<0.01). Ten-year post-AVS survival (P=0.9) and the progression of LV remodeling were similar between sexes (P≥0.16). Multivariable determinants of ACD and CVD were age, advanced symptoms, iAorta, LV ejection fraction (LVEF), LVESDi, LV end-systolic volume index (LVESVi), and Taiwanese ethnicity (all P<0.05), but not female sex (P≥0.05). AVS was associated with better survival (P<0.01). Adjusted LVEF, LVESDi, LVESVi, and iAortacut-off values for ACD were 53%, 24.8 mm/m, 44 mL/m, and 25.5 mm/m, respectively, in women and 52%, 23.4 mm/m, 52 mL/m, and 23.2 mm/m, respectively, in men.
Early detection and intervention using sex-specific cut-off values may improve survival in women with AR.
Subjects
Aortic regurgitation
Outcome
Sex differences
SDGs
Publisher
Japanese Circulation Society
Type
journal article