Why the study?
Sex differences in aortic stenosis pathophysiology, presentation, and ventricular adaptation can lead to diagnostic uncertainty, treatment delays, and worse outcomes in women, necessitating a better understanding to improve timely care.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“In our population, [men and women had] the exact same severity of the stenosis, but women were less often referred to surgery. And if you don't treat the disease, you cannot cure the patient.”
“Women tend to present with atypical symptoms for AS. They may experience dizziness and/or fatigue, for example, but dizziness and fatigue could be related to many other things. That patient, and even her physician, may miss the fact that it is a result of a serious heart condition.”
“Starting from diagnosis of aortic stenosis in women, they present quite differently than men. So, for example, women may complain of shortness of breath or chest pain more often than men. The heart also remodels in a different way in women than in men. For example, we are not going to see heavy calcification in a woman: it will be more fibrocalcific aortic stenosis, rather than the heavy calcific aortic stenosis that we see in men. When taking into account the aortic stenosis in women, especially because women are multitasking and have a huge responsibility daily, it may be underdiagnosed or non-diagnosed for years.”
Recognizing sex-specific differences in aortic stenosis pathophysiology and presentation is crucial, as women often present with paradoxical low-flow low-gradient AS and have better survival outcomes with TAVI compared to SAVR.
Severe aortic stenosis represents a growing burden of disease globally with a high risk of death if untreated. There are sex differences in the pathophysiological disease process affecting the aortic valve, patients’ clinical presentation, progression of valve disease, ventricular adaptation, timing of symptom onset, delays in diagnosis, and treatment strategies. Female patients are more likely than male patients to have preserved left ventricular function with concentric left ventricular hypertrophy and smaller left ventricular cavity sizes, which consequently produce low stroke volumes and more paradoxical low flow low gradient severe aortic stenosis. These differences can lead to diagnostic uncertainty resulting in delays to treatment and associated morbidity and mortality. The higher mortality rate reported in women in observational cohorts is multifactorial. It is influenced by delayed diagnosis, lower referral rates, older age at intervention and frailty; rather than female sex alone. There exist variations in the treatment and management of aortic stenosis with women being underdiagnosed and conservatively managed compared to men. A better understanding of the differences in pathophysiology, ventricular adaptation and haemodynamic effects between the sexes are key to improving diagnostic accuracy and referral for timely intervention. Women may require a more tailored approach to their lifetime management of aortic stenosis due to their smaller anatomy and greater comorbidity burden at presentation. This narrative review explores the epidemiology, pathophysiology, presentation, diagnosis and management of aortic stenosis in female patients.
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Khan et al. (2026) conducted a review in Aortic Stenosis. Female sex vs. Male sex was evaluated.
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