Scaling New Heights to Define Optimal Sex-Specific Criteria for Ventricular Remodeling in Response to Chronic Aortic Regurgitation in a SCMR Registry Study: The Impact of Indexing with Height vs Body Surface Area (RF_SA_455)

Saturday, February 1, 2025

9:50 AM – 10:00 AM East Coast USA Time

Location: Blue Room PreFunction

Presenting Author(s)

LD

Lydia DeAngelo, BA

Medical Student
Cleveland Clinic Lerner College of Medicine

Primary Author(s)

LD

Lydia DeAngelo, BA

Medical Student
Cleveland Clinic Lerner College of Medicine

Co-Author(s)

MC

Megan Covington, MD

Cardiology Fellow
Cleveland Clinic
AN

Aparna Narendrula, MD, MSc

Internal Medicine Resident
New York University Langone Medical Center
LT

Larisa Tereshchenko, MD, PhD

Associate Staff
Quantitative Health Sciences
IS

Isa Sande Mathias, MD

Cardiology Fellow
Houston Methodist DeBakey Heart & Vascular Center
AT

Albree Tower-Rader, MD

Instructor in Medicine
Massachusetts General Hospital
Maan Malahfji, MD

Assistant Professor of Medicine
Houston Methodist DeBakey Heart & Vascular Center
DG

Dakshin Gangadharamurthy, MD

Cardiology Fellow
The Ohio State University
AG

Akash Goyal, MD

Fellow
The Ohio State University
MT

Matthew S. Tong, DO

Associate Professor - Clinical
The Ohio State University
SL

Shizhen Liu, MD, PhD

CV Imaging Research Specialist
Piedmont Heart Institute
DS

Debbie Scandling, BSc

Research Associate
The Ohio State University
VP

Venkateshwar Polsani, MD

Director of CardioVascular MRI and CTA
Piedmont Heart Institute
ME

Michael D. Elliott, MD

Director of Cardiac MRI
Atrium Health
DP

Dermot Phelan, MD, PhD

Director of Cardiovascular Imaging
Atrium Health
DC

David Chen, PhD

Director of Artificial Intelligence
Cleveland Clinic
Orlando P. Simonetti, PhD

Professor
The Ohio State University
ROBERT M. JUDD, PhD

Professor Emeritus
Duke University
Duke University
Dipan J. Shah, MD

Chief, Division of Cardiovascular Imaging Director, Cardiovascular MRI Laboratory
Weill Cornell Medical College, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
Christopher Nguyen, PhD, FSCMR, FACC

Director, Cardiovascular Innovation Research Center
Cleveland Clinic
WT

Wilson Tang, MD

Cardiologist
Cleveland Clinic
Deborah Kwon, MD, FSCMR

Director of Cardiac MRI
Cleveland Clinic

Background: Despite research demonstrating sex-differences in LV remodeling and outcomes in chronic AR, guidelines for surgical intervention remain sex-agnostic based on symptom presentation and LV diameters indexed to BSA.^1,2,3 Previous studies indicate body composition differences between males and females lead to LV measurement misclassification using BSA alone.⁴Optimal alternative constructs for indexing LV size are not well established, though height indexed to the allometric 2.7 power is widely cited in prior echocardiographic studies.^4,5,6 Cardiac magnetic resonance (CMR) has demonstrated superiority in elucidating sex-differences compared to echocardiography.¹ Therefore, this study assessed sex-specific LV remodeling measured by CMR and its association with adverse outcomes using indexed measurements both by height and BSA in chronic AR.

Methods: In this multicenter retrospective cohort study from the SCMR registry, p</span>atients with an AR fraction (ARF) ≥20% by CMR or moderate AR by echocardiography were included from five US sites. LV end diastolic diameter (LVEDD), end systolic diameter (LVESD), end-diastolic volume (LVEDV), and end-systolic volume (LVESV) were indexed to both body surface area and height to the allometric 2.7 power. The composite outcome was heart failure hospitalization or all-cause mortality. Logistic regression adjusting for NYHA heart failure class, age, and LV measurements were completed and receiver operating curves (ROC) were generated. Thresholds for LV measurements associated with increasing risk for the composite outcome were determined using Youden index for univariate ROCs.

Results:

There were 979 patients in our study (22% female). Indexing by BSA, females presented with similar diameters compared to males, though smaller LV volumes were observed (Table 1, A). In contrast, LV diameters were larger in females compared to males when indexed by height, while LV volumes remained smaller in females (Table 1, B).

Risk prediction significantly improved when incorporating LVEDD, LVEDV, and LVESV indexed to height and LVESV indexed to BSA (Figure 1, A, C, D).

Univariable threshold estimates were developed for each LV measurement. Using both sex-neutral and sex-specific cut points, scatter plots separated patients into quadrants by BSA and height thresholds to determine the prevalence of discrepant measurements based on indexing method. For LVEDDi, more females met sex-agnostic height only criteria (25%, 56/222), compared to males (7.6%, 58/757). Similar trends were observed in LVESDi (12% vs. 6.3%). No females met only sex-neutral BSA criteria for either LV volumes and only 8.5% and 10%