Sex-differences in aortic stenosis: Effect on functional capacity and prognosis

Area of Science:

• Cardiology
• Exercise Physiology
• Sex Differences in Medicine

Background:

• Left ventricular (LV) remodeling in aortic stenosis (AS) presents distinct patterns between sexes.
• Previous research suggests potential sex-based variations in exercise testing responses.

Purpose of the Study:

• To investigate sex-specific differences in exercise testing measurements in patients with moderate to severe aortic stenosis.
• To identify factors influencing exercise capacity and their relationship with outcomes in men and women with AS.

Main Methods:

• Echocardiography and exercise tolerance testing (ETT) were performed on 316 patients with moderate or severe AS.
• Early rapid rise in heart rate (RR-HR) was defined as achieving ≥85% of target heart rate or a ≥50% increase from baseline within 6 minutes of ETT.
• Outcomes, including all-cause mortality, were tracked over a mean follow-up of 34.9 months.

Main Results:

• Men demonstrated longer treadmill walking times and higher metabolic equivalents (METs) compared to women, although peak heart rate and blood pressure were similar.
• Age and BMI influenced lower METs in men, while Z-value was a determinant in women.
• An early rapid rise in heart rate (RR-HR) was a significant predictor of lower METs in both sexes, but was associated with reduced event-free survival only in men.

Conclusions:

• Exercise capacity in aortic stenosis is generally lower in women, with differing determinants compared to men.
• While an early rapid heart rate rise during ETT is linked to reduced exercise capacity in both sexes, it specifically predicts poorer survival in men.