AUTHOR=Al Saikhan Lamia , Park Chloe , Tillin Therese , Jones Siana , Francis Darrel , Mayet Jamil , Chaturvedi Nish , Hughes Alun D. 

TITLE=Sex-differences in associations of LV structure and function measured by echocardiography with long-term risk of mortality and cardiovascular morbidity

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1144964

DOI=10.3389/fcvm.2023.1144964

ISSN=2297-055X

ABSTRACT=Background: Three-dimensional echocardiography(3DE) measures of the left ventricle(LV) predict mortality and morbidity in high risk individuals, but their prognostic value in the general population is unknown. Further, whether associations differ by sex is uncertain. 
Methods: 922 individuals(age, 69.7±6.2y [717 men: age, 69.9±6.1; 205 women: age, 69.0±6.5; p=0.085]) from the SABRE study underwent a health examination including echocardiography. Associations between 3DE LV measures(ejection fraction(EF), end-diastolic volume(EDV), end-systolic volume(ESV), LV remodeling index(LVRI) and LV sphericity index(LVSI), and all-cause mortality and a composite cardiovascular endpoint(comprising new onset (non)fatal coronary heart disease, heart failure hospitalization, new-onset arrhythmias and cardiovascular mortality) were determined using multivariable Cox regression over a median follow-up of 8y(all-cause mortality) and 7y(composite cardiovascular endpoint).
Results: There were 123 deaths and 151 composite cardiovascular endpoints. Lower EF, higher LV volumes and LVSI were associated with an increased risk of all-cause mortality, and higher LV volumes were associated with the composite cardiovascular endpoint independent of potential confounders. Associations between LV volumes, LVRI, LVSI, and mortality differed by sex(p interaction < 0.1): in men increased LV volumes and LVSI and decreased LVRI and EF were associated with increased risk of mortality, but associations were null or reversed in women(hazard ratios(95% CI) men vs women: EDV 1.25(1.05, 1.48) vs 0.54(0.26, 1.10); ESV, 1.36(1.12, 1.63) vs. 0.59(0.33, 1.04); LVRI, 0.79(0.64, 0.96) vs 1.70(1.03, 2.80); LVSI, 1.27(1.05, 1.54) vs 0.61(0.32, 1.15); and EF, 0.78(0.66, 0.93) vs 1.27(0.69, 2.33). Similar sex differences were observed for associations with the composite cardiovascular outcome. 
Conclusions: 3DE measures of LV volume and remodeling are associated with all-cause mortality and cardiovascular morbidity. However, the direction of several of these associations differs by sex, suggesting that sex-differences in LV remodeling patterns may influence mortality and morbidity risk in the general population.