Sex-specific differences in patients with significant aortic regurgitation

Abstract Background Significant aortic regurgitation (AR) leads to left ventricular (LV) remodelling and poor outcomes if untreated; however, data on sex-differences in the setting of significant AR is scare. Purpose To examine contemporary clinical and echocardiographic differences between men and women with significant chronic AR. Methods and results Consecutive patients with significant AR evaluated in a heart valve clinic following a comprehensive clinical and imaging protocol were included. Comparison was performed between genders. A total of 206 patients with significant AR were included (130 grade III, 76 grade IV AR) (mean age 69 years, 49% women). Mean follow-up was 3.7 years. Women showed similar comorbidities, but were older (66.5 vs 71.4, p=0.017), and more symptomatic. Women were smaller in terms of height, weight and surface area, showing significantly smaller volumes and diameters (LVEDD 52 ± 6.2 mm men vs 47.0 ±6.7 mm women, p<0.001). However, when diameters were normalized, no significant differences were seen between men and women. Hospital admissions due to heart failure and number of surgeries were not significantly different between genders. Conclusion In patients with significant AR, indication for intervention in guidelines is based on the same values for both men and women. However, women were more symptomatic and showed significantly smaller volumes and diameters. Indexed values should be considered in decision making taking into account differences in gender.