Gender related improvement in functional capacity after early aortic valve replacement in asymptomatic patients with severe aortic stenosis

Abstract

It has been shown that female gender is independent predictor of decreased functional capacity. Gender specific effect of early surgical aortic valve replacement (SAVR) on exercise capacity in asymptomatic patients with severe AS and normal left ventricular ejection fraction (LVEF) is unknown.

The aim of our study was to determine whether there is a difference in gender related changes in functional capacity after early SAVR in a group of asymptomatic patients with severe AS and normal LVEF randomized within AVATAR trial.

Method

157 asymptomatic patients with severe AS were enrolled prospectively and underwent cardiopulmonary exercise testing (CPET) on a bicycle ergometer (patient supine, RAMP protocol, 15 W/min) as a measure for functional capacity. Patients with proven ischemia, any symptom or LVEF < 50% were excluded from the study.

Results

157 patients (mean age, 67 years; 68 were women) were randomly allocated to early surgery or conservative treatment. 46 men and 32 women underwent early SAVR. There were no baseline gender differences in age (66.11 vs 64.8, p=ns), echo parameters of AS severity (Vmax 4.51 vs 4.54 m/s, and Pmean 52.2 vs 53.42 mmHg, or LVEF 67.7 vs 66.6%, all p=ns) . Women had higher body mass index (29.5 vs 27.3, p = 0.018), higher VE/VCO2 slope (35.6 vs 28, p=0.039), lower VO2max (12.70 vs 18.5ml/kg/m2 p<0.05), and achieved lower workload (129.4 vs 73.1watts, p<0.05) at baseline CPET. After 12 months in both genders in early SAVR group there was statistically insignificant increase in VO2max (men 18.5 to 22.2 ml/kg/m2, women 12.7 to 15.7 ml/kg/m2, p=ns respectively) and decrease in VE/VCO2 slope (35.6 to 32.8, p=ns) while only women significantly increased workload (73.2 to 90.3 watts, p=0.047, compared to 129.4 to 135 watts in men, p=ns)

Conclusion

For the same severity of AS and LVEF, in comparison to males, asymptomatic females have lower functional capacity but potentially greater functional benefit after early SAVRWorkload by Sex: Baseline to 12M Post-SAVR