Abstract 16639: Sex Differences in Progression of Aortic Stenosis and Cardiovascular Outcome. A SEAS Substudy
Background: Women with aortic stenosis (AS) have better left ventricular (LV) systolic function than men, as well as more concentric LV geometry in advanced disease stages. Sex differences in LV adaptation and prognosis during progression of AS have been less explored.
Methods: Doppler echocardiography and cardiovascular events were recorded during a median follow-up of 4.3 years in 979 men and 632 women aged 28-86 (mean 67±10) years participating in the Simvastatin Ezetimibe in Aortic Stenosis (SEAS) study. LV geometry was assessed by LV mass/height2.7 and relative wall thickness, thus categorizing patients with normal LV mass/height2.7 as having normal geometry or concentric remodeling, and patients with LV hypertrophy as having eccentric or concentric hypertrophy. Study outcomes were AS-related events and ischemic cardiovascular events, as well as total mortality.
Results: Women and men had similar progression of AS (annual reduction in aortic valve area index of 0.02cm2/m2) during follow-up. Prevalence of LV hypertrophy increased comparably in women and men, remaining considerably higher in men throughout the study, while prevalence of concentric remodeling increased more in women: 11% at baseline vs. 29% at the last visit (both p <0.001). Compared to women, more men developed low LV ejection fraction (<50%) and low midwall shortening (<14.2%) during follow-up (both p <0.05). In multivariate Cox analyses, male gender predicted 46% higher risk of ischemic cardiovascular events, in particular more stroke and coronary artery bypass grafting, as well as 43% higher risk of death, independent of AS severity, low LV function and LV geometry (Table). AS-related events did not differ between genders.
Conclusions: Men and women have a similar rate of AS progression. Men have higher prevalence of LV hypertrophy and systolic dysfunction at all stages of AS and experience more often ischemic cardiovascular events and death.
- © 2013 by American Heart Association, Inc.