Women with moderate aortic stenosis developed concentric hypertrophy and diastolic dysfunction at lower mean gradients than men, and more frequently presented with dyspnea (87.8% vs 74.8%; p=0.021).
Cohort (n=542)
Are there sex differences in longitudinal left ventricular myocardial changes and clinical outcomes in patients with moderate aortic stenosis?
Women with moderate aortic stenosis develop adverse left ventricular remodeling and diastolic dysfunction at lower transvalvular gradients than men, highlighting a sex-specific pathophysiological response to pressure overload.
Absolute Event Rate: 87.8% vs 74.8%
p-value: p=0.021
Abstract Background Sex differences in myocardial changes have been identified, but longitudinal investigations in moderate aortic stenosis populations are lacking. Aims To investigate sex differences in myocardial changes in aortic stenosis. Methods and Results We retrospectively collected longitudinal echocardiographic and clinical data of 542 patients with diagnosis of asymptomatic moderate aortic stenosis. Baseline was defined as the first echocardiogram showing non-severe aortic stenosis. We enrolled 205 (37.8%) females and 337 (62.2%) males with median age of 69 years and median follow-up duration of 6.47 years. Over the course of aortic stenosis, women had higher left ventricular ejection fraction, lower left ventricular mass index, larger relative wall thickness, and more diastolic dysfunction compared to men. Although the prevalence and incidence of concentric hypertrophy did not differ by sex, women developed concentric hypertrophy and diastolic dysfunction at lower mean gradients than men. Incidence and time of symptom occurrence did not differ by sex. Overall, 99 (48%) women and 148 (44%) men developed symptoms, at a median age of 73.4 64.2;81.0 years and a mean gradient of 39.8 31.5;47.5 mmHg, which was similar between sexes. When symptomatic, women more commonly presented with dyspnea (87.8% vs 74.8%; p=0.021). Incidence and time from baseline to aortic valve replacement and mortality were similar between men and women. Conclusions Women with aortic stenosis have worse diastolic function, develop concentric hypertrophy and diastolic dysfunction at lower mean gradients, and more often present with dyspnea. We observed no sex differences in time from baseline to replacement or mortality.
Panaou et al. (Wed,) conducted a cohort in asymptomatic moderate aortic stenosis (n=542). Female sex vs. Male sex was evaluated on Dyspnea presentation when symptomatic (p=0.021). Women with moderate aortic stenosis developed concentric hypertrophy and diastolic dysfunction at lower mean gradients than men, and more frequently presented with dyspnea (87.8% vs 74.8%; p=0.021).