Specificities of Aortic Stenosis in Women – From Diagnosis to Management

Figures

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  Fig. 1.. Pathophysiology of aortic stenosis according to sex. AS in women is mainly driven by increased fibrosis, while in men, valve calcification is more dominant. Concentric left ventricular remodeling with diffuse fibrosis is observed in women vs. more eccentric hypertrophy and focal fibrosis in men. AS: aortic stenosis, ECV: extracellular volume, LGE: late gadolinium enhancement.

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  Fig. 2.. Clinical presentation and early identification pathways of aortic stenosis in women. Women frequently present with fewer or atypical symptoms despite advanced disease, higher NYHA functional class, and later referral for valve intervention, leading to more advanced disease at diagnosis. The right panel highlights factors supporting earlier recognition of aortic stenosis in women, including demographic risk, subtle symptoms, elevated biomarkers, and imaging patterns that warrant earlier echocardiographic evaluation and intervention. AS: aortic stenosis; NYHA: New York heart association; AVR: aortic valve replacement; TAVI: transcatheter aortic valve implantation.

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  Fig. 3.. Echocardiographic findings in women and men with AS. Women typically present a smaller aortic annulus and root, concentric left ventricular remodeling, smaller left ventricular cavity size, lower stroke volume, and more pronounced diastolic dysfunction. In contrast, men more commonly exhibit a larger aortic annulus, eccentric remodeling or hypertrophy, larger left ventricular cavity size, and less severe diastolic dysfunction. LV: left ventricle.