Abstract 14052: Impact of Sex and Age on Left Ventricular Remodeling in Patients With Chronic Aortic Regurgitation

Abstract

Introduction: Women and older patients with chronic aortic regurgitation (AR) have disproportionately higher rates of adverse events compared to men and younger patients, respectively. Yet, guidelines recommend same left ventricular (LV) dimension thresholds for intervention in all. While experimental animal models suggest different rates of LV remodeling by sex and age, there is paucity of data in humans with AR Methods: We included consecutive patients with isolated moderate or severe AR who were serially monitored by echo between 2010 & 2016. The 2 main endpoints were change in LV volumes indexed to body surface area (LVEDVi & LVESVi ) and adverse events (heart failure hospitalization, urgent surgery, or death) Results: 786 patients [mean (SD) age 58 (16) yrs & 31% women] were included. Median (IQR) follow up was 25 (12-44) months. A moderate increase in LV volumes was observed overall, although women consistently had smaller LV volumes compared to men ( Fig 1 ). Similarly, compared to younger patients (<60 yrs), older patients (≥60 yrs) persistently had smaller LV volumes ( Fig 1 ). Despite having smaller LV volumes, women and older patients were more sensitive to change in LV volumes, with higher rate of events per unit increase in volume e.g., HR per unit increase in LVEDVi was 1.01 (1.00-1.02) for men and 1.03 (1.01-1.07) for women ( P int =0.01) ( Fig 2 ) Conclusions: Independent of BSA, women and older patients with significant AR maintained smaller LV volumes than men and younger patients, respectively, on serial evaluation. Yet, they were more sensitive to change in LV volume. Sex and age-specific LV volume thresholds for timing of AR surgery are needed to address disparity in outcomes