Women with bicuspid aortic valves exhibited a higher relative risk of death than men in tertiary (RR 1.67 vs 1.16; P=0.001) and surgical (RR 1.63 vs 1.34; P=0.026) referral cohorts.
Cohort (n=5,482)
Are there sex-related differences in morbidity and survival among adults with bicuspid aortic valves across different clinical stages?
Adults with bicuspid aortic valves face excess mortality in advanced clinical stages, with women experiencing a significantly higher relative risk of death than men, largely driven by aortic regurgitation.
Effect estimate: Relative death risk 1.67 (women) vs 1.16 (men) (95% CI 1.38-2.03 (women), 1.05-1.29 (men))
p-value: p=0.001
BACKGROUND: Sex-related differences in morbidity and survival in bicuspid aortic valve (BAV) adults are fundamentally unknown. Contemporary studies portend excellent survival for BAV patients identified at early echocardiographic-clinical stages. Whether BAV adults incur a survival disadvantage throughout subsequent echocardiographic-clinical stages remains undetermined. METHODS AND RESULTS: Analysis was done of 3 different cohorts of consecutive patients with echocardiographic diagnosis of BAV identified retrospectively: (1) a community cohort of 416 patients with first BAV diagnosis (age 35±21 years, follow-up 16±7 years), (2) a tertiary clinical referral cohort of 2824 BAV adults (age 51±16 years, follow-up 9±6 years), and (3) a surgical referral cohort of 2242 BAV adults referred for aortic valve replacement (AVR) (age 62±14 years, follow-up 6±5 years). For the community cohort, 20-year risks of aortic regurgitation (AR), AVR, and infective endocarditis were higher in men (all P≤0.04); for a total BAV-related morbidity risk of 52±4% vs 35±6% in women (P=0.01). The cohort's 25-year survival was identical to that in the general population (P=0.98). AR independently predicted mortality in women (P=0.001). Baseline AR was more common in men (P≤0.02) in the tertiary cohort, with 20-year survival lower than that in the general population (P<0.0001); age-adjusted relative death risk was 1.16 (95% confidence interval CI 1.05-1.29) for men versus 1.67 (95% CI 1.38-2.03) for women (P=0.001). AR independently predicted mortality in women (P=0.01). Baseline AR and infective endocarditis were higher in men (both ≤0.001) for the surgical referral cohort, with 15-year survival lower than that in the general population (P<0.0001); age-adjusted relative death risk was 1.34 (95% CI 1.22-1.47) for men versus 1.63 (95% CI 1.40-1.89) for women (P=0.026). AR and NYHA class independently predicted mortality in women (both P≤0.04). CONCLUSIONS: Within evolving echocardiographic-clinical stages, the long-term survival of adults with BAV is not benign, as both men and women incur excess mortality. Although BAV-related morbidity is higher in men in the community, and AR and infective endocarditis are more prevalent in men, women exhibit a significantly higher relative risk of death in tertiary and surgical referral cohorts, which is independently associated with AR.
Michelena et al. (Fri,) conducted a cohort in Bicuspid aortic valve (n=5,482). Sex (Female vs Male) vs. General population was evaluated on Long-term survival and mortality (Relative death risk 1.67 (women) vs 1.16 (men), 95% CI 1.38-2.03 (women), 1.05-1.29 (men), p=0.001). Women with bicuspid aortic valves exhibited a higher relative risk of death than men in tertiary (RR 1.67 vs 1.16; P=0.001) and surgical (RR 1.63 vs 1.34; P=0.026) referral cohorts.