Sex differences in clinical characteristics and outcomes of patients with moderate aortic stenosis and regurgitation
S Park, Y C Kim, Lee Jy, J H Son, J H Kim, E K Kim, S A Chang, S C Lee, S W ParkAbstract
Background
Sex-related differences are well recognized in isolated aortic stenosis (AS) and aortic regurgitation (AR). However, data on mixed aortic valve disease, particularly moderate AS with concomitant AR, remain limited.
Method
A total of 220 consecutive patients with moderate AS and moderate AR were retrospectively enrolled from three tertiary centers between 2008 and 2022. Patients with bicuspid aortic valve or significant mitral valve disease were excluded. The primary outcome was a composite of all-cause death or hospitalization for heart failure.
Results
The median age was 74 years, and 53.6% of patients were symptomatic at baseline. Baseline demographics and comorbidities were comparable between women and men. Men had significantly larger left ventricular (LV) dimensions, greater LV mass index, and lower LV ejection fraction (61.0% versus 64.5%; p=0.004) compared with women, resulting in a higher prevalence of LV systolic dysfunction (29.1% versus 10.9%). During follow-up, men experienced a significantly higher incidence of the primary outcome compared with women (adjusted hazard ratio 1.73, 95% confidence interval 1.15–2.60; p=0.009). In women, decreased renal dysfunction and atrial fibrillation were independently associated with adverse outcomes. In contrast, clinical factors were not significantly associated with adverse outcomes in men, whereas lower LV ejection fraction was an independent predictor.
Conclusion
In patients with moderate mixed aortic valve disease, men had a higher risk of death or hospitalization for heart failure compared with women. Predictors of adverse outcomes showed distinct patterns by sex, suggesting the potential need for sex-specific risk assessment in this population.Clinical outcomes stratified by sexSex-specific association between LVEF