Divergent Left Ventricular Remodeling by Sex in Adults With Overweight and Obesity: An Echocardiographic Geometry Analysis

BACKGROUND: Sex-specific differences in left ventricular (LV) geometry are poorly characterized across the obesity severity spectrum in real-world echocardiographic cohorts, and standard LVMI cut-offs derived from male or mixed-sex populations may systematically underclassify LVH in women. METHODS: males) and a relative wall thickness (RWT) cut-off of 0.42. Binary logistic regression evaluated sex as an independent predictor of LV geometry outcomes, adjusting for age and obesity class. RESULTS: ; p = 0.042), yet female sex independently predicted LVH by LVMI (OR 2.11, 95% CI 1.01-4.41; p = 0.047), a finding visible only with sex-specific thresholds. Overall concentric burden was similar (CR + CH: 47.6% vs. 46.9%), but pattern distribution differed: females more often showed CH (17.7% vs. 11.1%) and EH (15.3% vs. 7.4%), while males more frequently had normal geometry (42.0%) or CR (35.8%). The divergence was greatest in the overweight subgroup: CH was nearly threefold higher in females (34.8% vs. 12.8%), and RWT was significantly greater (0.470 vs. 0.385; p = 0.020). CONCLUSIONS: Female sex independently predicts LVH by LVMI despite lower mean LVMI, a paradox visible only when sex-specific echocardiographic thresholds are applied. Females and males carry similar overall concentric burdens but follow divergent geometric remodeling paths, a difference detectable at the overweight threshold. These findings underscore the necessity of sex-specific LVMI reference values in echocardiographic practice.