Sex-Related Differences in Medically Treated Moderate Aortic Stenosis

Jan Stassen, MD; Stephan M. Pio, MD; See Hooi Ewe, MD, PhD; Mohammed R. Amanullah, MD; Kensuke Hirasawa, MD, PhD; Steele C. Butcher, MD, MPhil; Gurpreet K. Singh, MD; Kenny Y.K. Sin, MD; Zee P. Ding, MD; Nicholas W.S. Chew, MD; Ching-Hui Sia, MD; William K.F. Kong, MD, PhD; Kian Keong Poh, MD; David J. Cohen, MD, MSc; Philippe Généreux, MD; Martin B. Leon, MD; Nina Ajmone Marsan, MD, PhD; Victoria Delgado, MD, PhD; Jeroen J. Bax, MD, PhD

Structural Heart (Jul 2022)

Sex-Related Differences in Medically Treated Moderate Aortic Stenosis

Jan Stassen, MD,
Stephan M. Pio, MD,
See Hooi Ewe, MD, PhD,
Mohammed R. Amanullah, MD,
Kensuke Hirasawa, MD, PhD,
Steele C. Butcher, MD, MPhil,
Gurpreet K. Singh, MD,
Kenny Y.K. Sin, MD,
Zee P. Ding, MD,
Nicholas W.S. Chew, MD,
Ching-Hui Sia, MD,
William K.F. Kong, MD, PhD,
Kian Keong Poh, MD,
David J. Cohen, MD, MSc,
Philippe Généreux, MD,
Martin B. Leon, MD,
Nina Ajmone Marsan, MD, PhD,
Victoria Delgado, MD, PhD,
Jeroen J. Bax, MD, PhD

Affiliations

Jan Stassen, MD: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Stephan M. Pio, MD: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
See Hooi Ewe, MD, PhD: Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
Mohammed R. Amanullah, MD: Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
Kensuke Hirasawa, MD, PhD: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Steele C. Butcher, MD, MPhil: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
Gurpreet K. Singh, MD: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Kenny Y.K. Sin, MD: Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
Zee P. Ding, MD: Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
Nicholas W.S. Chew, MD: Department of Cardiology, National University Heart Center Singapore, Singapore, Singapore
Ching-Hui Sia, MD: Department of Cardiology, National University Heart Center Singapore, Singapore, Singapore
William K.F. Kong, MD, PhD: Department of Cardiology, National University Heart Center Singapore, Singapore, Singapore
Kian Keong Poh, MD: Department of Cardiology, National University Heart Center Singapore, Singapore, Singapore
David J. Cohen, MD, MSc: Department of Cardiology, Saint Francis Hospital, Roslyn, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
Philippe Généreux, MD: Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA
Martin B. Leon, MD: Cardiovascular Research Foundation, New York, New York, USA; Department of Cardiology, Columbia University Irving Medical Center/New York – Presbyterian Hospital, New York, New York, USA
Nina Ajmone Marsan, MD, PhD: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Victoria Delgado, MD, PhD: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Jeroen J. Bax, MD, PhD: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Turku Heart Center, University of Turku and Turku University Hospital, Turku, Finland; Address correspondence to: Jeroen J. Bax, MD, PhD, Department of Cardiology, Heart Lung Center, Albinusdreef 2, Leiden 2300 RC, The Netherlands

Journal volume & issue: Vol. 6, no. 3
p. 100042

Abstract

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Background: Recent data showed poor long-term survival in patients with moderate AS. Although sex differences in left ventricular (LV) remodeling and outcome are well described in severe AS, it has not been evaluated in moderate AS. Methods: In this retrospective, multicenter study, patients with a first diagnosis of moderate AS diagnosed between 2001 and 2019 were identified. Clinical and echocardiographic parameters were recorded at baseline and compared between men and women. Patients were followed up for the primary endpoint of all-cause mortality with censoring at the time of aortic valve replacement. Results: A total of 1895 patients with moderate AS (age 73 ± 10 years, 52% male) were included. Women showed more concentric hypertrophy and had more pronounced LV diastolic dysfunction than men. During a median follow-up of 34 (13-60) months, 682 (36%) deaths occurred. Men showed significantly higher mortality rates at 3- and 5-year follow-up (30% and 48%, respectively) than women (26% and 39%, respectively) (p = 0.011). On multivariable analysis, male sex remained independently associated with mortality (hazard ratio 1.209; 95% CI: 1.024-1.428; p = 0.025). LV remodeling (according to LV mass index) was associated with worse outcomes (hazard ratio 1.003; CI: 1.001-1.005; p = 0.006), but no association was observed between the interaction of LV mass index and sex with outcomes. Conclusions: LV remodeling patterns are different between men and women having moderate AS. Male sex is associated with worse outcomes in patients with medically treated moderate AS. Further studies investigating the management of moderate AS in a sex-specific manner are needed.

Published in Structural Heart

ISSN: 2474-8706 (Print); 2474-8714 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system
Website: https://www.sciencedirect.com/journal/structural-heart

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