Left ventricular changes in moderate aortic stenosis in women compared to men

Sex differences in myocardial changes have been identified, but longitudinal investigations in moderate aortic stenosis populations are lacking. The objective of this study was to investigate sex differences in myocardial changes in aortic stenosis.

We retrospectively collected longitudinal echocardiographic and clinical data of 542 patients with a diagnosis of asymptomatic moderate aortic stenosis. Baseline was defined as the first echocardiogram showing non-severe aortic stenosis.We enrolled 205 (37.8%) females and 337 (62.2%) males, with a median age of 69 years and a median follow-up duration of 6.47 years.Over the course of aortic stenosis, women had higher left ventricular ejection fraction, lower left ventricular mass index, larger relative wall thickness, and more diastolic dysfunction compared to men. Although the prevalence and incidence of concentric hypertrophy did not differ by sex, women developed concentric hypertrophy and diastolic dysfunction at lower mean gradients than men.Incidence and time of symptom occurrence did not differ by sex. Overall, 99 (48%) women and 148 (44%) men developed symptoms, at a median age of 73.4 [64.2;81.0] years and a mean gradient of 39.8 [31.5;47.5] mmHg, which was similar between the sexes. When symptomatic, women more commonly presented with dyspnoea (87.8% vs. 74.8%; P = 0.021). Incidence and time from baseline to aortic valve replacement and mortality were similar between men and women.

Women with aortic stenosis have worse diastolic function, develop concentric hypertrophy and diastolic dysfunction at lower mean gradients, and more often present with dyspnoea. We observed no sex differences in time from baseline to replacement or mortality.

Women with moderate aortic stenosis developed concentric hypertrophy at lower mean gradients, had more and earlier diastolic dysfunction, and more often presented with dyspnoea compared to men. No difference was observed in outcomes. #vhdAS #TAVR #WomenInCardiology.