Sex-specific prognostic value of global longitudinal strain beyond ventricular remodeling in chronic severe aortic regurgitation
S Lee, C Y S ShimAbstract
Background
In chronic severe aortic regurgitation (AR), left ventricular (LV) remodeling and prognosis differ by sex. However, sex-specific differences in LV remodeling patterns and their prognostic implications remain incompletely defined.
Purpose
We aimed to investigate the sex differences in the degree of LV remodeling and clinical outcomes among patients with chronic severe AR.
Methods
We analyzed a multicenter cohort from three tertiary centers, including 1,149 patients (754 men, 403 women) with chronic severe AR. LV remodeling was assessed by echocardiographic linear, volumetric, and functional parameters, including LV ejection fraction (LVEF) and LV global longitudinal strain (LVGLS). The primary outcome was a composite of cardiac death or heart failure hospitalization. Aortic valve replacement was treated as a time-dependent covariate.
Results
Women had smaller absolute LV dimensions and volumes but relatively larger indexed LV end-systolic diameters, while indexed LV volumes remained smaller than in men. Despite these geometric differences, LV systolic function was better preserved in women, with higher LVEF and more favorable LVGLS. During a median follow-up of 6.2 years, women underwent aortic valve replacement less frequently than men (35.4% vs. 56.4%, p < 0.001), despite similar clinical outcomes. In sex-specific multivariable models, LV functional parameters demonstrated the robust prognostic performance in women, with LVGLS showing the highest discrimination (C-index, 0.78–0.79). In contrast, LV chamber size–related parameters were more predictive in men.
Conclusions
LV remodeling and its prognostic significance differ substantially by sex in chronic severe AR. In women, functional impairment assessed by LVGLS is particularly prognostic, even when conventional criteria are preserved. Incorporating LVGLS into a sex-specific approach may improve risk stratification and clinical decision-making in severe AR.Incremental prognostic value