Sex Differences in Aortic Valve Calcification Measured by Multidetector Computed Tomography in Aortic Stenosis

Abstract

A ortic stenosis (AS) is common in elderly people, affecting 2% of the population ≥65 years old and 4.6% of population ≥75 years old based on Doppler echocardiographic or community studies.1,2 Nowadays, the most common cause of AS is degenerative, and aortic valve calcification (AVC) is the intrinsic mechanism of valvular stiffening and obstruction. [3][4][5][6] Although degenerative AS has long been considered age related, recent studies have demonstrated that it is an active process involving biological pathways with many similarities to atherosclerosis. 7,8 Epidemiological studies identified similar risk factors for calcific AS and coronary atherosclerosis such as age, smoking, elevated cholesterol levels, diabetes mellitus, metabolic syndrome, hypertension, and increase in lipoprotein-a levels. 9 Male sex was also touted as an independent risk factor for AS similar to atherosclerosis, 9 but studies linking valve tissue alterations 10,11 and calcification to AS 12 have not differentiated between men and women. Moreover, studies of aortic valve weight as a surrogate for calcification load showed discordant results with regard to sex, 13,14 and clinically, guidelines do not differentiate between men and women for AS pathophysiology and management. 6 However, the analogy to atherosclerosis suggests that there may be important, yet thus far undefined, sex-related differences in the development of AVC and the transition to AS. This issue can now be analyzed because cardiac computed tomography (CT) provides accurate and reproducible quantification of AVC load, 15 and multidetector CT (MDCT) may prove to be a useful adjunct tool for the evaluation of AS severity. However, previous studies suggested a single set of cutoff values for detecting severe AS regardless of sex, 16 so the impact of sex on the relation between aortic cusp calcification measured by MDCT and hemodynamic severity of AS remains uncertain. The aim of the present study was to determine the differential physiological relationship between AVC Background-Aortic valve calcification (AVC) is the intrinsic mechanism of valvular obstruction leading to aortic stenosis (AS) and is measurable by multidetector computed tomography. The link between sex and AS is controversial and that with AVC is unknown. Methods and Results-We Conclusions-In Aggarwal et al Aortic Valve Calcification in Women 41load and AS hemodynamic severity between men and women. We hypothesized that women reach thresholds for severe AS for lower calcification loads than men and that when MDCT is used for the diagnosis of AS severity, criteria of AVC load would need to be adjusted specifically for each sex. Methods Study PopulationWe prospectively enrolled patients with at least mild calcific AS in whom we performed noncontrast MDCT scan for the evaluation of AVC and comprehensive transthoracic echocardiography within 90 Creatinine Clearance age k gPatients from the Bichat Hospital were enrolled in 2 ongoing prospective studies on aortic valve calcification/stenosis (COFRASA; www.clinica...

Sex Differences in the Utilization and Outcomes of Surgical Aortic Valve Replacement for Severe Aortic Stenosis

“…In addition, the focus of research on this topic has been to investigate sex differences in ventricular responses to pressure and volume overload posed by valvular disease rather than evaluating differences in the mechanism of AS itself 28. Nevertheless, 3 recent studies found important differences between men and women with regard to the development, extent, and progression of aortic valve calcifications supporting sex‐related differences in the mechanism of AS 29, 30, 31. Our findings of distinct risk profiles between men and women with AS at a community level support this notion and call for further research in sex‐specific disease mechanisms.…”

Impact of Vascular Hemodynamics on Aortic Stenosis Evaluation: New Insights Into the Pathophysiology of Normal Flow—Small Aortic Valve Area—Low Gradient Pattern

“…The summation of per‐slice lesion scores was performed individually for every aortic valve calcification score. In order to take into account the interpatient variability in valve size, we used the aortic valve calcification density, where aortic valve calcification was divided by the cross‐sectional aortic annulus area (π×[Aortic annulus diameter/2] 2 ) measured by echocardiography 14, 26, 27…”

Multimodality Imaging Strategies for the Assessment of Aortic Stenosis

“…16 Different cutoff values of aortic valve calcium score should be used in men (≥2000 AU or ≥480 AU/cm 2 ) versus women (≥1200 AU or ≥290 AU/ cm 2 ) to identify severe AS. 16,40 A potential explanation for this intriguing finding is that women have relatively more valvular fibrosis than men. Fibrosis may also contribute to valvular stenosis, but as opposed to calcification, it is not detected by MSCT.…”