In severe aortic stenosis with preserved LVEF, coronary artery disease predicts death in women (HR 1.85), while diabetes predicts death in men (HR 1.73).
Coronary artery disease is the primary independent predictor of mortality in women with symptomatic severe aortic stenosis and preserved ejection fraction, whereas diabetes is the primary predictor in men.
Absolute Event Rate: 0% vs 0%
Abstract Introduction Patients with symptomatic severe aortic stenosis (AS) are indicated for valve intervention, percutaneously or surgically. Left ventricular ejection fraction (LVEF) is widely recognized as one of the leading independent predictors of mortality in AS. However, among symptomatic AS and preserved LVEF – the most prevalent subgroup – the independent predictors of death may differ significantly between genders. Objective To analyse the independent predictors of death in AS with preserved LVEF in women and men. Methods We analysed 525 patients with AS and preserved LVEF (≥50%) with an indication for valve intervention between April 2020 and December 2024. Severe AS was confirmed by echocardiography, with criteria of mean transvalvular gradient ≥40 mmHg, aortic area ≤1.0 cm², or jet velocity ≥4.0 m/s. Clinical characteristics, echocardiographic parameters, and the presence of coronary artery disease (CAD), defined as lesions with luminal reduction 50%, were evaluated. We used Kaplan-Meier test and the Cox proportional hazards model to identify variables independently associated with all-cause death, adjusted for age, diabetes, LVEF, left ventricular mass index (LVMI), and CAD. Results The mean age was 75.4±10.6 years, and 313 (53%) were male. In a follow-up of 2.9±1.5 years, 216 (37%) deaths occurred, 170 (79%) of cardiovascular diseases and 46 (21%) to other causes. Among the patients, 91% had dyspnoea, 39% angina, and 15% syncope. Patients who died were older (77±10 vs. 75±11 years; p=0.026), had a higher prevalence of atrial fibrillation (AF) (20% vs. 14%; p=0.025), and had higher LVMI (121±31 vs. 113±30 g/m²; p=0.004). In men who died, we observed a higher prevalence of diabetes (43% vs. 27%; p=0.010) and lower LVEF (61±5 vs. 63±5; p=0.042). Among women who died, there was a higher prevalence of CAD (41% vs. 24%; p=0.007), AF (8% vs. 4%; p=0.010), and higher LVMI (118±33 vs. 109±30 g/m²; p=0.033). Cumulative mortality was higher in the presence of CAD (p=0.006) (Figure A). In the analysis by gender, this association was observed only in women (p=0.039) (Figure B). In the multivariate analysis, CAD HR=1.53 (95% CI: 1.14-2.05); p=0.004 and LVMI HR=1.01 (95% CI: 1.00-1.01); p=0.012 were independent variables associated with death in the total population. Among women, CAD HR=1.85 (95% CI: 1.19-2.87); p=0.005 was the main predictor of death, while in men, diabetes HR=1.73 (95% CI: 1.14-2.60); p=0.009. Conclusion The results showed the need for gender-specific approaches in AS. In women, a more detailed stratification of CAD is essential, while in men, drug control of diabetes should be intensified.Figure
Avakian et al. (Sat,) reported a other. In severe aortic stenosis with preserved LVEF, coronary artery disease predicts death in women (HR 1.85), while diabetes predicts death in men (HR 1.73).