IMPACT OF SEX ON THE MANAGEMENT AND OUTCOME OF AORTIC STENOSIS PATIENTS

Abstract

Sex-differences in management and outcome in aortic valve stenosis (AS) are controversial and poorly understood. The objective of this study was to examine the impact of sex and flow-gradient pattern of AS on aortic valve intervention and mortality in a large cohort of patients with AS. We analyzed the Doppler-echocardiography prospectively collected between 2005 and 2015 from patients with at least mild AS (aortic valve area: AVA≤1.5cm2 or peak aortic jet velocity: Vpeak≥2m/s). We excluded patients with ejection fraction < 50%, mitral or aortic insufficiency > mild or incomplete echocardiography. Outcomes were retrospectively retrieved from the Québec Institute of Statistics. Among 3379 patients, 58% were men and mean age was 70.7±12.6 years, indexed AVA (AVAi) 0.47±0.16, mean gradient (MG) 34.7±19.4 and Vpeak 3.8±0.9m/s. Women were older, had more hypertension and symptoms while less coronary artery disease compared to men (Table). Stenosis severity was equivalent between men and women, ejection fraction was higher in women than in men, but indexed stroke volume was comparable between sexes (Table). During a mean follow-up of 4.00±3.26 years, there were 872 (25.93%) deaths. After adjustment for age, diabetes, hypertension, renal disease, coronary artery disease, chronic pulmonary disease, symptoms, AVAi, MG and indexed stroke volume, female sex was associated with a 17% over-mortality (1.17 [1.01-1.36]; p=0.04). Interestingly, after comprehensive adjustment, men underwent 13% more aortic valve intervention (1.13 [1.05-1.22]; p=0.0011) than women, which may explain the sex-difference in mortality after diagnosis. In this series of AS patients, men represent the majority of patients (58%). Despite similar AS severity at diagnosis, women were less referred to aortic valve intervention (13%) and incurred more mortality (17%).View Large Image Figure ViewerDownload Hi-res image Download (PPT)