Does Gender Influence the Indication of Treatment and Long-Term Prognosis in Severe Aortic Stenosis?

Introduction: It is a matter of controversy whether the therapeutic strategy for severe aortic stenosis (AS) differs according to gender. Methods: Retrospective study of patients diagnosed with severe AS (transvalvular mean gradient >= 40 mmHg and/or aortic valvular area < 1 cm(2)) between 200...

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Detalles Bibliográficos
Autores: Gil Llopis C, Valls Serral A, Roldán Torres I, Contreras Tornero MB, Cuevas Vilaplana A, Sorribes Alonso A, Escribano Escribano P, Gimeno Tio P, Galiana Talavera E, Geraldo Martínez J, Gramage Sanchis P, Mateos AH, Mora Llabata V
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2023
País:España
Institución:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
Repositorio:r-FISABIO. Repositorio Institucional de Producción Científica
OAI Identifier:oai:fisabio.fundanetsuite.com:p14845
Acceso en línea:https://fisabio.portalinvestigacion.com/publicaciones/14845
Access Level:acceso abierto
Palabra clave:aortic valve stenosis
sex differences
aortic valve replacement
mortality
treatment outcome
Descripción
Sumario:Introduction: It is a matter of controversy whether the therapeutic strategy for severe aortic stenosis (AS) differs according to gender. Methods: Retrospective study of patients diagnosed with severe AS (transvalvular mean gradient >= 40 mmHg and/or aortic valvular area < 1 cm(2)) between 2009 and 2019. Our aim was to assess the association of sex on AVR or medical management and outcomes in patients with severe AS. Results: 452 patients were included. Women (51.1%) were older than men (80 +/- 8.4 vs. 75.8 +/- 9.9 years; p < 0.001). Aortic valve replacement (AVR) was performed less frequently in women (43.4% vs. 53.2%; p = 0.03), but multivariate analyses showed that sex was not an independent predictor factor for AVR. Age, Charlson index and symptoms were predictive factors (OR 0.81 [0.82-0.89], OR 0.81 [0.71-0.93], OR 22.02 [6.77-71.64]). Survival analysis revealed no significant association of sex within all-cause and cardiovascular mortalities (log-rank p = 0.63 and p = 0.07). Cox proportional hazards analyses showed AVR (HR: 0.1 [0.06-0.15]), Charlson index (HR: 1.13 [1.06-1.21]) and reduced LVEF (HR: 1.9 [1.32-2.73]) to be independent cardiovascular mortality predictors. Conclusions: Gender is not associated with AVR or long-term prognosis. Cardiovascular mortality was associated with older age, more comorbidity and worse LVEF.

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