{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T03:38:55Z","timestamp":1792035535772,"version":"4.4.0"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2020,2,18]]},"abstract":"\n Background<\/jats:title>\n \n Increased left ventricular (\n LV<\/jats:styled-content>\n ) mass is characterized by increased myocardial wall thickness and\/or ventricular dilatation that is associated with worse outcomes. We aim to comprehensively compare sex\u2010stratified associations between measures of\n LV<\/jats:styled-content>\n remodeling and increasing\n LV<\/jats:styled-content>\n mass in the general population.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n Participants were prospectively recruited in the National Heart Center Singapore Biobank to examine health and cardiovascular risk factors in the general population. Cardiovascular magnetic resonance was performed in all individuals. Participants with established cardiovascular diseases and abnormal cardiovascular magnetic resonance scan results were excluded. Global and regional measures of\n LV<\/jats:styled-content>\n remodeling (geometry, function, interstitial volumes, and wall stress) were performed using conventional image analysis and novel 3\u2010dimensional machine learning phenotyping. Sex\u2010stratified analyses were performed in 1005 participants (57% males; 53\u00b113\u00a0years). Age and prevalence of cardiovascular risk factors were well\u2010matched in both sexes (\n P<\/jats:italic>\n >0.05 for all). Progressive increase in\n LV<\/jats:styled-content>\n mass was associated with increased concentricity in either sex, but to a greater extent in females. Compared with males, females had higher wall stress (mean difference: 170\u00a0mm\u00a0Hg,\n P<\/jats:italic>\n <0.0001) despite smaller\n LV<\/jats:styled-content>\n mass (42.4\u00b18.2 versus 55.6\u00b114.2\u00a0g\/m\n 2<\/jats:sup>\n ,\n P<\/jats:italic>\n <0.0001), lower blood pressures (\n P<\/jats:italic>\n <0.0001), and higher\n LV<\/jats:styled-content>\n ejection fraction (61.9\u00b15.9% versus 58.6\u00b16.4%,\n P<\/jats:italic>\n <0.0001). The regions of increased concentric remodeling corresponded to regions of increased wall stress. Compared with males, females had increased extracellular volume fraction (27.1\u00b12.4% versus 25.1\u00b12.9%,\n P<\/jats:italic>\n <0.0001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Compared with males, females have lower\n LV<\/jats:styled-content>\n mass, increased wall stress, and concentric remodeling. These findings provide mechanistic insights that females are susceptible to particular cardiovascular complications.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.119.014781","type":"journal-article","created":{"date-parts":[[2020,2,12]],"date-time":"2020-02-12T10:00:44Z","timestamp":1581501644000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Paradoxical Higher Myocardial Wall Stress and Increased Cardiac Remodeling Despite Lower Mass in Females"],"prefix":"10.1161","volume":"9","author":[{"given":"Andrew I. H.","family":"Phua","sequence":"first","affiliation":[{"name":"College of Medicine and Public Health Flinders University Adelaide South Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thu\u2010Thao","family":"Le","sequence":"additional","affiliation":[{"name":"National Heart Research Institute Singapore National Heart Center Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Su W.","family":"Tara","sequence":"additional","affiliation":[{"name":"College of Medicine and Public Health Flinders University Adelaide South Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"De Marvao","sequence":"additional","affiliation":[{"name":"MRC London Institute of Medical Sciences Imperial College London London United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinming","family":"Duan","sequence":"additional","affiliation":[{"name":"MRC London Institute of Medical Sciences Imperial College London London United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Desiree\u2010Faye","family":"Toh","sequence":"additional","affiliation":[{"name":"National Heart Research Institute Singapore National Heart Center Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Briana","family":"Ang","sequence":"additional","affiliation":[{"name":"National Heart Research Institute Singapore National Heart Center Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer A.","family":"Bryant","sequence":"additional","affiliation":[{"name":"National Heart Research Institute Singapore National Heart Center Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Declan P.","family":"O'Regan","sequence":"additional","affiliation":[{"name":"MRC London Institute of Medical Sciences Imperial College London London United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stuart A.","family":"Cook","sequence":"additional","affiliation":[{"name":"National Heart Research Institute Singapore National Heart Center Singapore Singapore"},{"name":"Department of Cardiology National Heart Center Singapore Singapore"},{"name":"Cardiovascular Sciences ACP Duke NUS Medical School Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Calvin W. L.","family":"Chin","sequence":"additional","affiliation":[{"name":"National Heart Research Institute Singapore National Heart Center Singapore Singapore"},{"name":"Department of Cardiology National Heart Center Singapore Singapore"},{"name":"Cardiovascular Sciences ACP Duke NUS Medical School Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199005313222203"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.102.4.470"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0167-5273(99)00114-X"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(93)90678-6"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(97)00398-6"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1186\/1532-429X-16-16"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2015.08.007"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12968-016-0236-3"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12968-017-0413-z"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jet245"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1109\/TMI.2019.2894322"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/bioinformatics\/btx552"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.86.4.1099"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.09.065"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2019.01.044"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.05.078"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jey034"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jey057"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.105.541078"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehs070"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.2174\/1573403X09666131202125424"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.119.014781","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T11:28:00Z","timestamp":1715599680000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.119.014781"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2,18]]},"references-count":21,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2020,2,18]]}},"alternative-id":["10.1161\/JAHA.119.014781"],"URL":"https:\/\/doi.org\/10.1161\/jaha.119.014781","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,2,18]]},"assertion":[{"value":"2019-09-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-01-02","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-02-12","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e014781"}}