Aortic stenosis in women

Shan, Ying; Pellikka, Patricia A.

doi:10.1136/heartjnl-2019-315407

Cited by 26 publications

(23 citation statements)

References 50 publications

(60 reference statements)

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“…However, sex differences have been observed in terms of valvular anatomy, calcification, and fibrosis in patients with AS 4 . Left ventricular remodeling in response to chronic pressure overload in AS may differ in both genders: Women often exhibited lower left ventricular mass but higher relative wall thickness and better left ventricular ejection fraction for similar AS severity and comorbidities, 14–16 similar to our findings.…”

Section: Discussionsupporting

confidence: 84%

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Outcome implication of sex‐related effective orifice area normalized to body size in aortic stenosis

et al. 2020

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Introduction Although several echocardiographic parameters have different values according to sex, there are no studies in echocardiographic variables of aortic stenosis (AS) severity. Our aim was to evaluate the sex‐related prognosis of several echocardiographic parameters in AS. Methods Two hundred and twenty‐five patients with at least moderate AS (effective orifice area [EOA] ≤ 1.50 cm2) were prospectively enrolled. EOA was normalized to body surface area (BSA), height, and body mass index (BMI). Receiver operating characteristic curves, in women and men separately, were plotted to determine the best cutoff value for predicting cardiovascular death. Results The largest area under the curve (AUC) to predict cardiovascular death was EOA in men (AUC 0.74, P < .001) and EOA/height in women (AUC 0.81, P < .001). An EOA/height cutoff value of 0.55 cm2/m in women had a sensitivity of 100% and specificity of 61%; a cutoff of 0.50 cm2/m in men obtained a sensitivity of 92% and a specificity of 56%. During a mean follow‐up of 247 ± 183 days, there were 33 cardiovascular deaths. Women with EOA/height ≤ 0.55 cm2/m had higher cardiovascular mortality (22% vs 0%, P < .001) and men with EOA/height ≤ 0.50 cm2/m (21% vs 2%, P < .001). One‐year survival in women with EOA/height ≤ 0.55 cm2/m was 67 ± 8% and 100 ± 0% in EOA/height > 0.55 cm2/m (P < .001). In men, 1‐year survival was 70 ± 8% in EOA/height ≤ 0.50 cm2/m, and 93 ± 6% in EOA/height > 0.50 cm2/m (P = .004). Conclusions Normalization of EOA is useful in AS, especially in women. We recommend using an EOA/height cutoff value of 0.55 cm2/m in women, and 0.50 cm2/m in men to identify a subgroup with higher cardiovascular risk.

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Section: Discussionsupporting

confidence: 84%

“…Although epidemiological studies have indicated a similar prevalence of AS between men and women, sex differences have been detected in pathophysiology, clinical presentation, and outcomes 4 . Indeed, several studies found higher performance of surgical aortic valve replacement in men 5,6 .…”

Section: Introductionmentioning

confidence: 99%

Outcome implication of sex‐related effective orifice area normalized to body size in aortic stenosis

et al. 2020

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“…14,15 For a given aortic valve area and/or mean gradient females tend to have higher amount of fi brosis and a greater proportion of dense connective tissue in aortic valve as compared to males. 16,17 Women also appear to obtain a greater degree of diffuse fi brosis during chronic pressure overload. Demonstrated with cardiac MRI (CMRI), women often have smaller LV cavity size and more pronounced concentric remodeling/hypertrophy 18,19 compared with men who have AS of similar severity and with similar comorbidities.…”

Section: Discussionmentioning

confidence: 99%

Gender specific differences in functional capacity in asymptomatic patients with severe aortic stenosis

Banović¹,

Brković²,

Pěnička³

et al. 2021

Cor Vasa

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Ženské pohlaví je spojováno se zvýšeným rizikem nežádoucích příhod po chirurgické náhradě aortální chlopně, avšak s lepším výsledným stavem po katetrizační implantaci aortální chlopně (TAVI). Méně se toho již ví o rozdílech mezi pohlavími ve funkční kapacitě s těžkou aortální stenózou (AS). Cílem naší studie bylo zjistit, zda existuje rozdíl mezi pohlavími ve funkční kapacitě u skupiny asymptomatických pacientů s těžkou AS. Metoda: Asymptomatičtí pacienti s těžkou AS byli zařazováni prospektivně a absolvovali kardiopulmonální zátěžové vyšetření (cardiopulmonary exercise testing, CPET) na bicyklovém ergometru (pacient v poloze na zádech, protokol RAMP, 15 W/min). Pacienti s prokázanou ischemií byli ze studie vyřazeni. Výsledky: Do studie bylo zařazeno celkem 139 pacientů, z toho 61 žen. Při vstupním vyšetření nebyly mezi pohlavími nalezeny žádné rozdíly ve věku (66,11 vs. 64,8 roku; p = ns), echokardiografi ckými parametry závažnosti AS (V max 4,53 vs. 4,53 m/s ani P mean 52,27 vs. 53,42 mm Hg, vše p = ns), až na hodnoty AVA (0,75 ± 0,1 vs. 0,63 ± 0,17), EF LK (68,7 vs. 71,6 %), E/e' (12,6 vs. 14,3) a BNP (92,5 vs. 103 pg/ml), vše p = ns. Ženy měly vyšší hodnoty BMI (29,5 vs. 27,3; p = 0,018), nižší VO 2max (13,10 vs. 17,6 ml/kg/m 2 ; p = 0,001) a vyšší VE/VCO 2 slope (33,69 vs. 28,87; p = 0,004). K určení vztahu mezi klinickými a echokardiografi ckými charakteristikami s VO 2max byly provedeny univariační/multivariační lineární regresní analýzy. Proměnnými nezávisle spojenými s VO 2max byly ženské pohlaví (beta = -0,365; p = 0,002), V max (beta = -0,341; p = 0,004), věk (beta = -0,239; p = 0,035) a BMI (beta = -0,246; p = 0,028) Závěr: Ženské pohlaví je nejsilnější nezávislý prediktor snížené funkční kapacity, a to i po adjustaci na ostatní proměnné včetně BMI a echokardiografi ckých markerů závažnosti AS. Ke zjištění, zda výše uvedená fakta nějak ovlivňují výsledný stav pacienta po onemocnění, je třeba provést další studie.

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“…Other relevant factors include persistent hypertension, 14 coronary artery disease, and chronic kidney failure 15 . The best timing of AVR to achieve the most complete regression of hypertrophy and provide the best long‐term prognosis on the basis of the patient's sex is an issue that deserves further investigation 16 …”

Section: Introductionmentioning

confidence: 99%

Surgical aortic valve replacement and left ventricular remodeling: Survival and sex‐related differences

et al. 2021

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Objectives To analyze how left ventricular (LV) remodeling and hypertrophy geometry evolve after surgical aortic valve replacement (SAVR) in octogenarian patients, and identify potential sex‐related differences and implications for long‐term outcomes. Methods In 170 patients with aortic stenosis ([AS], age 80 ± 4 years, 59% women), hypertrophy geometry and remodeling (LV index) were reanalyzed one year post‐SAVR. The six‐year outcomes were evaluated. Results Pre‐SAVR, 65% of the women and 38.6% of the men (P < .001) showed adaptive remodeling. Concentric hypertrophy was prevalent in adaptive remodeling, and mixed and dilated hypertrophy were more prevalent in maladaptive remodeling. At one year, the remodeling patterns and sex distribution were similar to those observed pre‐SAVR, but the LV index decreased in women and increased in men (P < .0001). Women with adaptive remodeling had a higher incidence of persistent concentric hypertrophy with higher LV filling pressures. Long‐term survival was better in women and worse in men with adaptive remodeling (P = .039). Men with adaptive remodeling and men with concentric hypertrophy had the highest risk of cardiac death. This risk was similar between sexes for patients with maladaptive remodeling and dilated hypertrophy. Women with LV ejection fraction >55% had a lower risk of cardiac death than men. Conclusions The long‐term outcomes of SAVR differ between sexes in older patients with AS and adaptive LV remodeling. The LV index facilitates studying the pathways of adaptation to AS. The follow‐up shifts help explain the sex differences in long‐term outcomes post‐SAVR. Concentric hypertrophy is associated with the highest risk of cardiac death in men.

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Aortic stenosis in women

Cited by 26 publications

References 50 publications

Outcome implication of sex‐related effective orifice area normalized to body size in aortic stenosis

Outcome implication of sex‐related effective orifice area normalized to body size in aortic stenosis

Gender specific differences in functional capacity in asymptomatic patients with severe aortic stenosis

Surgical aortic valve replacement and left ventricular remodeling: Survival and sex‐related differences

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