{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:11:32Z","timestamp":1760148692228,"version":"build-2065373602"},"reference-count":14,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,5,23]],"date-time":"2023-05-23T00:00:00Z","timestamp":1684800000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Objectives: We sought to evaluate the effect of gender on biology, therapeutic decisions, and survival in patients with severe aortic regurgitation (AR). Background: Gender affects adaptive response to the presence of valvular heart diseases and therapeutic decisions. The impact of these on survival in severe AR patients is not known. Methods: This observational study was compiled from our echocardiographic database which was screened (1993\u20132007) for patients with severe AR. Detailed chart reviews were performed. Mortality data were obtained from the Social Security Death Index and analyzed as a function of gender. Results: Of the 756 patients with severe AR, 308 (41%) were women. Over a follow-up of up to 22 years, there were 434 deaths. Women compared to men were older (64 \u00b1 18 vs. 59 \u00b1 17 years, p = 0.0002). Women also had smaller left ventricular (LV) end diastolic dimension (5.2 \u00b1 1.1 vs. 6.0 \u00b1 1.0 cm, p &lt; 0.0001), higher EF (56% \u00b1 17% vs. 52% \u00b1 18%, p = 0.003), higher prevalence of diabetes mellitus (18% vs. 11%, p = 0.006), and higher prevalence of \u22652+ mitral regurgitation (52% vs. 40%, p = 0.0008) despite a smaller LV size. Women were also less likely to receive aortic valve replacement (AVR) (24% vs. 48%, p &lt; 0.0001) compared to men and had a lower survival on univariate analysis (p = 0.001). However, after adjusting for group differences including AVR rates, gender was not an independent predictor of survival. However, the survival benefit associated with AVR was similar in both women and men. Conclusions: This study strongly suggests that female gender is associated with different biological responses to AR compared to men. There is also a lower AVR rate in women, but women derive similar survival benefit as men with AVR. Gender does not seem to affect survival in an independent fashion in patients with severe AR after adjusting for group differences and AVR rates.<\/jats:p>","DOI":"10.3390\/medsci11020036","type":"journal-article","created":{"date-parts":[[2023,5,23]],"date-time":"2023-05-23T07:00:02Z","timestamp":1684825202000},"page":"36","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Gender Effects on Left Ventricular Responses and Survival in Patients with Severe Aortic Regurgitation: Results from a Cohort of 756 Patients with up to 22 Years of Follow-Up"],"prefix":"10.3390","volume":"11","author":[{"given":"Padmini","family":"Varadarajan","sequence":"first","affiliation":[{"name":"Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA 92521, USA"},{"name":"Division of Cardiology, Riverside School of Medicine, University of California, Riverside, CA 92521, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ramdas G.","family":"Pai","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Riverside School of Medicine, University of California, Riverside, CA 92521, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1016\/S0140-6736(06)69208-8","article-title":"Burden of valvular heart disease: A population-based study","volume":"368","author":"Nkomo","year":"2006","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/S1010-7940(98)00268-1","article-title":"Gender differences in patients with severe aortic stenosis: Impact on preoperative left ventricular geometry and function, as well as early postoperative morbidity and mortality","volume":"15","author":"Wallentina","year":"1999","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1016\/S0735-1097(99)00165-5","article-title":"Gender differences in molecular remodeling in pressure overload hypertrophy","volume":"34","author":"Weinberg","year":"1999","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.echo.2017.01.007","article-title":"Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance","volume":"30","author":"Zoghbi","year":"2017","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1016\/j.jacc.2009.02.077","article-title":"Effect of Beta-Blocker Therapy on Survival in Patients With Severe Aortic Regurgitation: Results From a Cohort of 756 Patients","volume":"54","author":"Sampat","year":"2009","journal-title":"J. Am. Coll. 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Fail."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1038\/s41598-017-00855-9","article-title":"Female rats with severe left ventricular volume overload exhibit more cardiac hypertrophy but fewer myocardial transcriptional changes than males","volume":"7","author":"Beaumont","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e006370","DOI":"10.1161\/JAHA.117.006370","article-title":"Sex Differences in the Utilization and Outcomes of Surgical Aortic Valve Replacement for Severe Aortic Stenosis","volume":"6","author":"Chaker","year":"2017","journal-title":"J. Am. Hear. Assoc."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1016\/j.ijsu.2009.03.005","article-title":"Gender differences in outcomes following aortic valve replacement surgery","volume":"7","author":"Hamed","year":"2009","journal-title":"Int. J. Surg."}],"container-title":["Medical Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3271\/11\/2\/36\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:40:08Z","timestamp":1760125208000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3271\/11\/2\/36"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,23]]},"references-count":14,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,6]]}},"alternative-id":["medsci11020036"],"URL":"https:\/\/doi.org\/10.3390\/medsci11020036","relation":{},"ISSN":["2076-3271"],"issn-type":[{"type":"electronic","value":"2076-3271"}],"subject":[],"published":{"date-parts":[[2023,5,23]]}}}