aortic regurgitation (AR). Current clinical guidelines largely rely on uniform thresholds for surgical decision-making, despite growing evidence that
cardiac remodeling differs between women and men.
Left ventricular dilatation is a key marker used to guide the timing of aortic valve surgery in AR. Existing recommendations primarily focus on the LV end-systolic diameter index (LVESDi), applying the same cutoff for both sexes. Although LV end-systolic volume index (LVESVi) may offer a more comprehensive assessment of ventricular remodeling, it has only recently been incorporated into guidelines, again using a single threshold regardless of sex. The investigators sought to determine whether sex-specific thresholds for these measures were more closely associated with mortality risk.
The multicenter cohort study included patients with moderate to severe AR and preserved left ventricular ejection fraction (≥50%) treated between December 2003 and December 2022. The analysis drew data from five centers across the Netherlands, Singapore, Hong Kong, Canada, and Romania, with a median follow-up of seven years. Patients with symptoms, acute AR, significant additional valvular disease, or prior valve surgery were excluded to focus on asymptomatic individuals managed medically at baseline.
The authors concluded that lower LVESDi thresholds than those currently recommended, along with sex-specific LVESVi cutoffs, may improve risk stratification in asymptomatic patients with moderate to severe AR. These findings suggest that incorporating sex-based differences in ventricular remodeling into clinical decision-making could allow for more timely intervention and potentially improved outcomes.
Lopez Santi P, Fortuni F, Bernard J, et al. Sex Differences in Left Ventricular Remodeling for Risk Stratification of Patients With Aortic Regurgitation. JAMA Cardiol. Published online January 21, 2026. doi:10.1001/jamacardio.2025.5249
Disclaimer: This website is primarily for healthcare professionals. The content here does not replace medical advice and should not be used as medical, diagnostic, endorsement, treatment, or prescription advice. Medical science evolves rapidly, and we strive to keep our information current. If you find any discrepancies, please contact us at corrections@medicaldialogues.in. Read our Correction Policy here. Nothing here should be used as a substitute for medical advice, diagnosis, or treatment. We do not endorse any healthcare advice that contradicts a physician's guidance. Use of this site is subject to our Terms of Use, Privacy Policy, and Advertisement Policy. For more details, read our Full Disclaimer here.
NOTE: Join us in combating medical misinformation. If you encounter a questionable health, medical, or medical education claim, email us at factcheck@medicaldialogues.in for evaluation.