In asymptomatic patients with severe aortic stenosis, indexed aortic valve area was the most significant mortality predictor in males, while females exhibited more pronounced transmitral flows.
Do clinical, echocardiographic parameters, and prognostic characteristics differ by sex in asymptomatic patients with hemodynamically severe aortic stenosis?
Males and females with asymptomatic severe aortic stenosis exhibit different patterns of left ventricular remodeling and functional adaptation, highlighting the potential need for sex-specific clinical management and timing of intervention.
Introduction: Aortic stenosis (AS) is the most common valvular disease in developed countries, and its course and clinical presentation can significantly vary depending on the patient's gender. The aim of this study was to identify sex-specific differences in morphological, functional, and prognostic characteristics in asymptomatic patients with hemodynamically severe AS. Methods: This retrospective observational study included 116 patients (50 female and 66 male) with asymptomatic severe AS (AVA 1.5cm², Vmax 3.5 m/s, Pmean 30 mmHg). All participants underwent transthoracic echocardiography, and morphological, functional, and hemodynamic parameters were analyzed, as well as patterns of left ventricular remodeling and diastolic function. Patients were followed for 24 months, and predictors of mortality and major adverse cardiovascular events (MACE) were evaluated. Results: Male had larger dimensions and volumes of the left ventricle, while female exhibited more pronounced transmitral flows and a higher cardiac index. The indexed aortic valve area (AVAi) was the most significant predictor of mortality in male. Survival during follow-up was low in both groups, with no statistically significant difference between sexes. However, a trend toward shorter survival was observed in female. Conclusion: Although male and female with severe AS have a similar hemodynamic profile, they differ in patterns of remodeling and functional adaptation. Clinical management should be sex-specific, focusing on structural changes in male and on functional parameters and symptoms in female, in order to timely identify high-risk patients and optimize the timing of intervention.
Vujović et al. (2025) studied this question. In asymptomatic patients with severe aortic stenosis, indexed aortic valve area was the most significant mortality predictor in males, while females exhibited more pronounced transmitral flows.