Key result
Women with AS and reduced LVEF receive fewer AVRs and face ~39% higher conservative mortality.
Why the study?
Women with aortic stenosis are less frequently referred for AVR and face higher mortality risk than men, but whether this sex discrepancy exists in the context of reduced LVEF is unknown.
Do women with ≥moderate aortic stenosis and reduced LVEF have different rates of aortic valve replacement and all-cause mortality compared to men?
Cohort (n=827)
No
Do women with ≥moderate aortic stenosis and reduced LVEF have different rates of aortic valve replacement and all-cause mortality compared to men?
Hazard Ratio: 1.39
p-value: p=0.02
Women with significant aortic stenosis and reduced LVEF are less likely to receive aortic valve replacement and have higher mortality when treated conservatively compared to men, despite deriving similar survival benefits from the intervention.
BACKGROUND: Women with aortic stenosis (AS) tend to be less referred for aortic valve replacement (AVR) and suffer from higher mortality risk compared to men. It is unknown if this discrepancy between sexes is also observed in the context of reduced left ventricular ejection fraction (LVEF). The objective of this study was to compare the risk of all-cause mortality between women and men with AS and reduced LVEF. METHODS: We conducted a retrospective study of all patients presenting ≥moderate AS and LVEF<50% on echocardiography at the Quebec Heart and Lung Institute (2005-2018). Using governmental registry data, we compared the odds of AVR (surgical and transcatheter) and the risk of all-cause mortality between sexes. Models were adjusted for relevant comorbidities, LVEF, AS severity and AVR as a time-dependent covariable. RESULTS: Our cohort included 827 patients (38% women), aged 75 ± 11 years and with a median LVEF of 37% (quartile interval 30%-44%). After adjustment, women were less likely to undergo AVR (adjusted OR=0.58, p=0.007) and presented a higher mortality risk than men when treated conservatively (sub-distribution adjusted HR=1.39, p=0.02). There was no interaction between sex and AVR with regards to survival (p=0.13). CONCLUSIONS: Among patients with significant AS and reduced LVEF, women were less likely to undergo AVR and suffered from higher mortality risk when treated conservatively, when compared to men with similar AS severity. Both sexes derived similar survival benefit from AVR. Studies are needed to better understand the potential gaps and biases explaining these findings.
No takes yet. Share an insight, caveat, or question.
Paquin et al. (2025) conducted a cohort in Aortic stenosis with reduced ejection fraction (n=827). Female sex vs. Male sex was evaluated on All-cause mortality when treated conservatively (HR 1.39, p=0.02). Among patients with significant AS and reduced LVEF, women had a higher mortality risk than men when treated conservatively (HR 1.39; p=0.02) and were less likely to undergo AVR.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: