Background: Gender differences in valvular heart disease are increasingly recognised. Prior study has suggested better surgical outcomes in women with symptomatic severe aortic stenosis (AS). We investigate gender differences in medically-managed severe AS.
Methods: We compared gender differences in clinical, echocardiographic characteristics and outcomes in 347 patients with isolated severe AS (aortic valve area<1cm2) with preserved left ventricular ejection fraction (LVEF) that were medically-managed. Univariate and multivariate analyses were employed, and Kaplan-Meier curves were constructed to compare mortality outcomes.
Results: 205 (59%) patients were women. Despite higher incidences of hypertension (76% vs 43%) and diabetes mellitus (47% vs 30%) in women, they had better survival than men (Kaplan-Meier log-rank=6.24,p=0.012, Figure). After adjusting for age (Hazard ratio (HR) 1.034, 95%CI 1.014 - 1.054), hypertension (HR 1.469, 95%CI 0.807 - 2.673) and diabetes (HR 1.219, 95%CI 0.693 - 2.145) using Cox proportional hazards regression model, female gender remained independently associated with lower mortality (HR 0.561, 95%CI 0.332 - 0.947, p=0.030). Women tended to have smaller left ventricular sizes and smaller LV outflow tract diameter, but were similar to men in terms of LVEF, AS severity, and patterns of LV remodelling.
Conclusions: Women have better outcomes compared to men in medically-managed isolated severe AS with normal LVEF. These gender differences warrant further study and may affect prognostication, follow-up and timing of valve surgery.