Objective:

To evaluate sex-specific remodeling patterns and the prognostic value of ventricular geometry and non-invasive myocardial work following LVAD implantation.

Approach:

Key Findings:

• Men exhibited adverse sphericalization (median ΔLVSI +0.045, p = 0.001) and a significant decline in PDI (median Δ −1.475, p < 0.001).
• Women showed stable LVSI (ΔLVSI p = 0.766) and a non-significant change in PDI (median ΔPDI −0.922, p = 0.130), while maintaining higher absolute PDI at 6 months (p = 0.041).
• Preoperative LVSI was independently associated with mortality (HR 1.47 per SD, p = 0.034).
• Preoperative global work index (GWI) was a robust independent predictor of both mortality (HR 0.14 per SD, p < 0.001) and postoperative right heart failure (OR 0.41 per SD, p = 0.022).

Interpretation:

Women demonstrated preserved LV geometry and PDI after LVAD implantation, while men experienced adverse changes.

Limitations:

• Small sample size may limit the generalizability of the findings.
• Statistical significance was attenuated after propensity-score matching.

Conclusion:

Findings indicate that LVSI and myocardial work may have implications for risk stratification.

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