Following aortic valve replacement, women had similar all-cause mortality to men (20.5% vs 23.3%, p=0.114) but higher cardiovascular mortality (13.7% vs 8.5%, p=0.012).
Observational (n=674)
Yes
Are there sex differences in left ventricular remodelling, myocardial fibrosis, and mortality in patients undergoing SAVR or TAVR for severe aortic stenosis?
Men demonstrate more advanced LV remodelling in severe AS, while higher cardiovascular mortality in women post-AVR is driven by higher baseline risk and less bicuspid anatomy rather than sex itself.
Absolute Event Rate: 20.5% vs 23.3%
p-value: p=0.114
OBJECTIVES: To investigate sex differences in left ventricular remodelling and outcome in patients undergoing surgical or transcatheter aortic valve replacement (SAVR/TAVR). METHODS: In this multicentre, observational, outcome study with imaging core-lab analysis, patients with severe aortic stenosis (AS) listed for intervention at one of six UK centres were prospectively recruited and underwent cardiovascular magnetic resonance imaging. The primary endpoint was all-cause mortality and secondary endpoint was cardiovascular mortality. RESULTS: 674 patients (425 men, 249 women, age 75±14 years) were included: 399 SAVR, 275 TAVR. Women were older, had higher surgical risk scores and underwent TAVR more frequently (53% vs 33.6%, p<0.001). More men had bicuspid aortic valves (BAVs) (26.7% vs 14.9%, p<0.001) and demonstrated more advanced remodelling than women. During a median follow-up of 3.6 years, 145 (21.5%) patients died, with no significant sex difference in all-cause mortality (23.3% vs 20.5%, p=0.114), but higher cardiovascular mortality in women (13.7% vs 8.5%, p=0.012). There were no significant sex-related differences in outcome in the SAVR or TAVR subgroups, or after excluding those with BAV. Factors independently associated with all-cause mortality were age, left ventricular ejection fraction (LVEF), BAV (better) and myocardial fibrosis detected with late gadolinium enhancement (LGE) in men, and age, LVEF and LGE in women. Age and LGE were independently associated with cardiovascular mortality in both sexes. CONCLUSIONS: Men demonstrate more advanced remodelling in response to a similar severity of AS. The higher cardiovascular mortality observed in women following AVR is accounted for by women having less BAV and higher risk scores resulting in more TAVR. LGE is associated with a worse prognosis in both sexes.
Singh et al. (Thu,) conducted a observational in severe aortic stenosis (n=674). Female sex vs. Male sex was evaluated on all-cause mortality (p=0.114). Following aortic valve replacement, women had similar all-cause mortality to men (20.5% vs 23.3%, p=0.114) but higher cardiovascular mortality (13.7% vs 8.5%, p=0.012).