Department of Cardiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, Yawkey 5B, Boston, MA, 02114, USA.
Department of Cardiology, Houston Methodist Hospital, Weill Cornell Medical College, 6565 Fannin St., Houston, TX, 77030, USA.
J Cardiovasc Magn Reson. 2022 Feb 22;24(1):12. doi: 10.1186/s12968-022-00845-5.
Significant aortic regurgitation (AR) leads to left ventricular (LV) remodeling; however, little data exist regarding sex-based differences in LV remodeling in this setting. We sought to compare LV remodeling and AR severity, assessed by echocardiography and cardiovascular magnetic resonance (CMR), to discern sex-based differences.
Patients with ≥ moderate chronic AR by echocardiography who underwent CMR within 90 days between December 2005 and October 2015 were included. Nonlinear regression models were built to assess the effect of AR regurgitant fraction (RF) on LV remodeling. A generalized linear model and Bland Altman analyses were constructed to evaluate differences between CMR and echocardiography. Referral for surgical intervention based on symptoms and LV remodeling was evaluated.
Of the 243 patients (48.3 ± 16.6 years, 58 (24%) female), 119 (49%) underwent surgical intervention with a primary indication of severe AR, 97 (82%) men, 22 (18%) women. Significant sex differences in LV remodeling emerged on CMR. Women demonstrated significantly smaller LV end-diastolic volume index (LVEDVI) (96.8 ml/m vs 125.6 ml/m, p < 0.001), LV end-systolic volume index (LVESVI) (41.1 vs 54.5 ml/m, p < 0.001), blunted LV dilation in the setting of increasing AR severity (LVEDVI p value < 0.001, LVESVI p value 0.011), and LV length indexed (8.32 vs 9.69 cm, p < 0.001). On Bland Altman analysis, a significant interaction with sex and LV diameters was evident, demonstrating a significant increase in the difference between CMR and echocardiography measurements as the LV enlarged in women: LVEDVI (p = 0.006), LVESVI (p < 0.001), such that echocardiographic measurements increasingly underestimated LV diameters in women as the LV enlarged. LV length was higher for males with a linear effect from RF (p < 0.001), with LV length increasing at a higher rate with increasing RF for males compared to females (two-way interaction with sex p = 0.005). Sphericity volume index was higher for men after adjusting for a relative wall thickness (p = 0.033).
CMR assessment of chronic AR revealed significant sex differences in LV remodeling and significant echocardiographic underestimation of LV dilation, particularly in women. Defining optimal sex-based CMR thresholds for surgical referral should be further developed.
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严重主动脉瓣反流（AR）可导致左心室（LV）重构；然而，关于这种情况下基于性别的 LV 重构差异的数据很少。我们试图通过超声心动图和心血管磁共振（CMR）来比较 LV 重构和 AR 严重程度，以发现基于性别的差异。
纳入 2005 年 12 月至 2015 年 10 月期间因超声心动图检查发现≥中度慢性 AR 而在 90 天内接受 CMR 的患者。采用非线性回归模型评估 AR 反流量分数（RF）对 LV 重构的影响。构建了广义线性模型和 Bland Altman 分析来评估 CMR 和超声心动图之间的差异。根据症状和 LV 重构评估了手术干预的转诊。
在 243 名患者（48.3±16.6 岁，58 名[24%]女性）中，119 名（49%）因严重 AR 接受了手术干预，其中 97 名（82%）为男性，22 名（18%）为女性。CMR 显示 LV 重构存在显著的性别差异。女性的 LV 舒张末期容积指数（LVEDVI）显著较小（96.8ml/m 对 125.6ml/m，p<0.001），LV 收缩末期容积指数（LVESVI）较小（41.1 对 54.5ml/m，p<0.001），随着 AR 严重程度的增加，LV 扩张程度降低（LVEDVI p 值<0.001，LVESVI p 值 0.011），LV 长度指数也降低（8.32 对 9.69cm，p<0.001）。在 Bland Altman 分析中，LV 直径的性别交互作用显著，表明随着女性 LV 增大，CMR 和超声心动图测量之间的差异显著增加：LVEDVI（p=0.006），LVESVI（p<0.001），因此随着女性 LV 增大，超声心动图测量值对 LV 直径的低估程度逐渐增加。男性的 LV 长度随着 RF 的线性效应而增加（p<0.001），与女性相比，男性随着 RF 的增加，LV 长度的增加速度更高（性别双向交互作用 p=0.005）。校正相对壁厚度后，男性的球形体积指数较高（p=0.033）。
慢性 AR 的 CMR 评估显示 LV 重构存在显著的性别差异，以及超声心动图对 LV 扩张的显著低估，尤其是在女性中。应进一步制定基于性别的 CMR 手术转诊的最佳阈值。
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