Valvular & structural heart diseaseCohort study
Sex Differences in the Progression and Long-Term Outcomes of Native Mild to Moderate Aortic Stenosis
- Retrospective cohort study
- single-centre echocardiographic database
- propensity-matched analysis
Authors' conclusion
Women with mild to moderate AS had slower hemodynamic progression of AS, were more likely to have preserved left ventricular ejection fraction and concentric left ventricular hypertrophy in addition to lower incidence of AVR compared with men despite similar mortality.
Study context
- Population
- Patients with mild to moderate native tricuspid aortic stenosis (AS), Cleveland Clinic echocardiographic database, 2008–2016, followed until 201842.5% women
- Participants
- 2,549 patients
- Exposure
- Women vs men
- Outcome
- All-cause mortality, AVR and disease progression (annualized changes in echocardiographic parameters)
- Follow-up
- 10 years
Main finding
All-cause mortality and AVR
Adjusted hazard ratio
0.81
95% CI 0.67–0.91
P = 0.009
Women vs Men
adjusted HR 0.81 (95% CI 0.67–0.91); P = 0.009
As reported in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | Women | Men |
|---|---|---|
| Annualized disease progression (propensity-matched) | ||
| Mean gradient | 1.15 mm Hg/y | 2.10 mm Hg/y |
| Maximum transvalvular velocity | 0.28 m/s/y | 0.42 m/s/y |
| LV end-diastolic diameter | 0.048 mm/m2.7/y | 0.15 mm/m2.7/y |
- Annualized disease progression (propensity-matched): 1:1 propensity-matched analysis
- Annualized disease progression (propensity-matched): mean gradient P < 0.001
- Annualized disease progression (propensity-matched): LV end-diastolic diameter P = 0.014
Follow-up echocardiography
- Women had significantly higher LVEF, filling pressures and LV septum thickness over time vs men
Original publication
Sex Differences in the Progression and Long-Term Outcomes of Native Mild to Moderate Aortic Stenosis. JACC Cardiovasc Imaging. Published 26 July 2023. doi:10.1016/j.jcmg.2023.06.006
Summarised from the published abstract; every number is checked against it