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Sex differences in aortic stenosis progression and cardiac damage
Session:
Comunicações Orais - Sessão 02 - Doença aórtica
Speaker:
Rita Veiga
Congress:
CPC 2024
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.7 Valvular Heart Disease - Other
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Rita Veiga; Rafael Silva Teixeira; Fábio Sousa Nunes; Marta Leite; Inês Neves; Marta Catarina Almeida; André Lobo; Mariana Brandão; Diogo Santos; Francisco Sampaio; Ricardo Fontes-Carvalho
Abstract
<p style="text-align:start"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Background: Aortic Stenosis (AS) stands as a major valvular heart disease with increasing burden in developed countries. AS induces increased afterload and left ventricle (LV) remodeling, leading to gradual cardiac damage (CD), which can extend beyond the LV. Different sex-specific patterns of cardiac remodeling and damage have been reported, although prevailing guidelines still advocate identical echo-doppler criteria for diagnosing and grading AS in both women and men. Whether these different patterns are caused by sex-related AS progression rate or myocardial response is still unknown.</span></span></span></p> <p style="text-align:start"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Aim: We aim to compare longitudinal changes in aortic valve and cardiac function between women and men with AS to investigate sex-related differences in AS progression and cardiac remodeling.</span></span></span></p> <p style="text-align:start"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Methods: Patients with mild-to-severe AS and LV ejection fraction (LVEF) ≥ 50% at least in 2 echocardiograms (TTE) were retrospectively identified. Prosthetic and bicuspid valves were excluded. Serial TTEs provided a multiparametric framework to compare AS severity, progression rate and induced cardiac alterations between sexes.</span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Results: 914 patients were included (median follow-up time of 6.8 years) and 52% (473) were female. Both sexes had similar baseline aortic peak velocities (APV) (2.9±0.9 m/s), mean pressure gradient (MPG) (27±13mmHg) and LVEF (60±5%). Women were older (75±9 vs 73±8 years; p<0.001), had smaller body surface area (BSA) (1.70±0.15 vs 1.88±0.16m2, p<0.001), proportionally lower stroke volume (SV) (82±19mL vs 91±22mL, p<0.001), lower indexed LV mass (iLVM) (118±33g/m2 vs 125±28 g/m2, p<0.001) and higher indexed left atrium (LA) volume (39±13 vs 49±20mL/m2, , p<0.001). The average annualized progression rate of APV and MPG was similar for both groups (2 mmHg/year and 0.14 m.s-1.year-1). After multivariate adjustment, women had a higher incidence of severe LV hypertrophy (HR= 1.44, CI= 1.08-1.91, p=0.01), moderate-to-severe tricuspid regurgitation (TR) and pulmonary hypertension (PHT) (HR= 1.55, CI= 1.06-2.25, p=0.02) at 5 years. Rapid progressive AS is associated with more CD.</span></span></span></p> <p style="text-align:start"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Conclusion: This study suggests that in analogous static and dynamic loading conditions, women will develop severe LV hypertrophy, PHT and significant TR earlier than men. These patterns of CD could reflect sex-specific responses and suggests that the definition of AS severity may benefit from a shift from a valve-focused to a myocardial-integrative approach considering gender.</span></span></span></p>
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