Abstract 14914: Sex-Related Differences in Aortic Stenosis: Pre-operative Hemodynamics and Correlates of Aortic Valve Weight
Introduction: Valve weight in calcific aortic stenosis (AS) is thought to be mostly secondary to calcification and female sex is associated with less calcium burden. Contemporary data describing sex-related differences in pre-operative clinical characteristics, hemodynamics, and postoperative aortic valve weight (AVW) are scarce.
Hypothesis: AVW will correlate well with CT calcium score and female sex will be associated with lower AVW even after correction for anthropomorphic and clinical factors.
Methods: Postoperative AVW was measured in 1090 consecutive patients (692 male, 398 female) with AS.
Results: Women were slightly older (74±11 vs 73±10 years, p=0.04), had more hypertension (79% vs 73%, p=0.04), slightly higher NYHA functional class (2.64±0.71 vs 2.51±0.72, p=0.004), and less coronary artery disease (39% vs 54%, p<0.0001). Women had higher ejection fraction (63±10 vs 59±12, p<0.0001) and smaller aortic valve area (0.80±0.19 vs 0.91±0.18 cm2, p<0.0001), but had a similar indexed valve area (0.44±0.09 vs 0.44±0.10 cm2/m2, p=0.49) and mean gradient (51±15 vs 49±14 mm Hg, p=0.10). In 142 patients, CT aortic valve calcium score correlated well with AVW (r=0.80, p<0.0001) and was lower in women compared to men (2400±1170 AU vs 3557±1616, p<0.0001). Univariate and multivariate discriminators of AVW can be found in table 1.
Conclusions: CT coronary calcium scoring correlates well with AVW and the major correlates of increased AVW are male sex, bicuspid valve, and increased left ventricular outflow tract size. Despite a similar severity of AS, women had less aortic valve calcium and lower AVW compared to men even after correction for other confounding variables. This may be related to a greater degree of aortic valve fibrosis than calcification in women and/or varying adaptability to AS in men versus women. Examination of potential sex-related differences in the pathophysiology of AS may be helpful in elucidating potential non-surgical targets to treat AS.
Author Disclosures: J. Thaden: None. N.T. Vuyisile: None. R.M. Suri: None. J.J. Maleszewski: None. D.J. Soderberg: None. M. Clavel: None. S.V. Pislaru: None. J.F. Malouf: None. T.A. Foley: None. W.D. Edwards: None. M.E. Enriquez-Sarano: None.
- © 2014 by American Heart Association, Inc.