P303Prognostic value of diastolic wall strain in patients with asymptomatic severe aortic stenosis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y Suwa ◽  
Y Miyasaka ◽  
N Taniguchi ◽  
S Harada ◽  
I Shiojima
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Wall Thickness ◽  
Severe Aortic Stenosis ◽  
Posterior Wall ◽  
Left Ventricular ◽  
Aortic Valve Area ◽  
Kaplan Meier ◽  
Posterior Wall Thickness ◽  
Diastolic Wall Strain

Abstract Background Diastolic wall strain (DWS) has been reported to be associated with left ventricular (LV) stiffness and worse clinical outcomes. We sought to assess the utility of this new index for prediction of prognosis in asymptomatic patients with severe aortic stenosis (AS). Methods Asymptomatic severe AS patients [peak flow velocity (PFV) ≥4.0m/s, mean pressure gradient (mPG) ≥40mmHg, aortic valve area (AVA) ≤1.0cm2, or indexed AVA ≤0.6cm2/m2)] diagnosed between July 2007 and April 2016 were included in this study. Patients with significant mitral valve disease, posterior wall motion abnormality, prior cardiac surgery, hypertrophic cardiomyopathy, and LV ejection fraction <50% were excluded. DWS was calculated with a validated formula [DWS = (posterior wall thickness at end-systole − posterior wall thickness at end-diastole)/posterior wall thickness at end-systole]. All study patients were prospectively followed up to last visit or death until November 2017, and predictive value of all-cause death was assessed using Cox-proportional hazards modeling. Patients who underwent aortic valve replacement (AVR) during the study period were censored on the date of surgery. Results A total of 184 asymptomatic severe AS, 138 (age 76±9year-old, men 41%, PFV 3.9±1.0m/s, mPG 38±19mmHg, AVA 0.83±0.18cm2, indexed AVA 0.56±0.13cm2/m2) met all study criteria. Of whom, 43 (31%) underwent AVR and 28 (20%) died during a mean follow-up of 25±28months. In a multivariable model after adjusting for clinical and echocardiographic variables, advancing age (per10yrs; HR=2.19, 95% CI=1.19–4.03, P<0.05), history of hemodialysis (HR=4.31, 95% CI=1.30–14.35, P<0.05), and low-DWS (DWS <0.30) (HR=2.83, 95% CI=1.25–6.40, P<0.05) were independent predictors of all-cause death. In the Kaplan-Meier estimates of cumulative survival stratified by DWS status were shown (Figure). The Kaplan-Meier estimates of survival Conclusion Low-DWS provides prognostic information in patients with asymptomatic severe AS.

Abstract 155: Prevalence and Clinical Correlates of Left Ventricular Hypertrophy by Sokolow-Lyon and Cornell Electrocardiogram Voltage Criteria in Transcatheter Aortic Valve Replacement Patients

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Emily Xiao ◽  
Augustin Delago ◽  
Mohammad El-Hajjar ◽  
Batyrjan Bulibek ◽  
Mikhail Torosoff
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Retrospective Chart Review ◽  
Left Ventricular ◽  
Aortic Valve Area ◽  
Chi Square ◽  
Cornell Voltage

Background and Hypothesis: The sensitivity of LVH analysis by ECG voltage criteria in patients with severe aortic valve stenosis undergoing trans-catheter aortic valve replacement (TAVR) has not yet been studied. LVH is expected in the TAVR population and would be reflected in voltage criteria by ECG. Methods: A retrospective chart review was conducted in 176 consecutive TAVR patients without ventricular-paced rhythm. ECG data was collected and analyzed by Sokolow-Lyon and Cornell Voltage criteria. Results were compared to transthoracic echocardiogram. Analyses of variation, correlation, chi-square, and logistic regression were used. The study was approved by the institutional IRB. Results: Sokolow-Lyon and Cornell Voltage criteria for LVH were present and concordant in 19% (33 of 176) of patients; in 49% (86 of 176) of patients, neither criteria was suggestive for LVH. Only 19% (34 of 176) of patients had LVH by Cornell Voltage and 13% (23 of 176) by Sokolow-Lyon criteria, indicative of poor concordance between these two commonly used ECG criteria for LVH (p<0.0001). Ejection fraction, aortic valve gradient, aortic valve area, COPD, PVD, prior stroke, dyslipidemia, and hypertension did not affect the prevalence of LVH by either or both criteria. Women (p<0.01) and patients with rhythm other than atrial fibrillation (p<0.0053) were more likely to have voltage criteria for LVH, while older adults were more likely to meet criteria for LVH. Concordant LVH criteria were noted in patients 84.6 +/- 7.2 years of age, while patients without LVH by ECG voltage criteria were significantly younger at 80.21 +/- 8.1 years of age (p<0.007). Conclusion: The presence of LVH by Sokolow-Lyon and Cornell ECG voltage criteria poorly correlates with the presence of LVH and critical aortic stenosis in TAVR patients. Women are more likely to have voltage criteria for LVH. Therefore, ECG may not be a suitable method of screening patients with severe aortic stenosis for LVH, especially in men.

scholarly journals End-systolic wall stress in aortic stenosis: comparing symptomatic and asymptomatic patients

Open Heart ◽  
2019 ◽  
Vol 6 (1) ◽  
pp. e001021 ◽  
Author(s):  
Rasmus Carter-Storch ◽  
Jacob Eifer Moller ◽  
Nicolaj Lyhne Christensen ◽  
Lars Melholt Rasmussen ◽  
Redi Pecini ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Wall Thickness ◽  
Global Longitudinal Strain ◽  
Wall Stress ◽  
Left Ventricular ◽  
Volume Index ◽  
Aortic Valve Area ◽  
The Impact ◽  
Systolic Wall Stress

AimsIn aortic stenosis (AS), there is poor association between symptoms and conventional markers of AS severity or left ventricular (LV) systolic function. This may reflect that symptoms arise from LV diastolic dysfunction or that aortic valve area (AVA) and transvalvular gradient do not reflect afterload. We aimed to study the impact of afterload (end-systolic wall stress [ESWS]) on the presence of symptoms in AS and to test whether symptoms are related to increased ESWS or LV remodelling.Methods and resultsIn a prospective study, ESWS was estimated by measuring LV wall thickness from MRI and estimated LV end systolic pressure from echocardiographic mean gradient and systolic blood pressure in 78 patients with severe AS scheduled for aortic valve replacement and 91 patients with asymptomatic severe AS. Symptomatic patients had lower indexed AVA (0.40±0.11 vs 0.45±0.09 cm2/m2, p=0.009). They had undergone more extensive remodelling (MRI LV mass index [LVMi]: 85±24 vs 69±17 g/m2, p<0.0001), had higher tricuspid regurgitant gradient (24±8 mm Hg vs 19 ± 7 mm Hg, p=0.0001) and poorer global longitudinal strain (−15.6±3.8 vs −19.9±3.2%, p<0.0001). ESWS was higher among symptomatic patients (96±51 vs 76±25 kdynes/cm2, p=0.003). Multivariate logistic regression identified echocardiographic relative wall thickness, tricuspid gradient, mitral deceleration time, early diastolic strain rate, MRI LVMi, MRI LV end-diastolic volume index and ESWS as independently associated with being symptomatic.ConclusionESWS can be estimated from multimodality imaging combining MRI and echocardiography. It is correlated with LV remodelling and neurohormonal activation and is independently associated with symptomatic status in AS.

Abstract 18065: Combining Echo Doppler and CT Derived LVOT Measurements Improve Accuracy of Continuity Equation Based Aortic Valve Area Determination

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Sami Alnasser ◽  
Asim Cheema ◽  
Vamshi Kotha ◽  
Djeven Deva ◽  
Jeremy Edwards ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Correlation Coefficient ◽  
Continuity Equation ◽  
Severe Aortic Stenosis ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Aortic Valve Area ◽  
Left Ventricular Outflow ◽  
Valve Area

Background: Left ventricular outflow tract (LVOT) measurement by Echo falsely assumes circular LVOT with implications for aortic valve area (AVA) determined using continuity equation. In this study, we investigated the utility of combining Echo Doppler and computed tomography (CT) based LVOT area for precise AVA assessment. Methods: AVA-echo was calculated using continuity equation and standard echocardiography techniques. CT-LVOT area was measured by 3 independent readers. Blinded measurements were obtained in candidates for percutaneous aortic valve replacement. AVA-CT was calculated using CT-LVOT area and echo Doppler measurements. The inter-observer variability for CT-LVOT area and correlation between AVA-echo and AVA-CT was analyzed using intra-class (ICC) and Spearman correlation coefficient. Results: Complete data for 66 patients was analyzed. The ICC for CT derived LVOT measurement by three observers was 0.96 demonstrating excellent reliability. The LVOT area by echo was significantly smaller than that obtained by CT (3.43±0.8 vs. 4.45±1.2 cm2, p<0.0001) and showing moderate correlation (r=0.66, p=0.006). Similarly, the AVA-echo was significantly lower compared to AVA-CT (0.76±0.46 vs. 0.97±0.53 cm2, p<0.0001). The correlation coefficient for AVA-echo and AVA-CT was 0.7 (p < 0.0001), 0.4 (p=0.06) and 0.9 (p<0.0001) for AVA-echo of 0.8 cm2 respectively. The regression analysis showed that AVA-CT could be predicted by applying a correction factor to the AVA-echo as AVA-CT = AVA-echo x 1.1+0.14. Conclusion: CT provides accurate and reliable LVOT assessment. Combining CT-LVOT and echo Doppler measurements result in a larger AVA compared to AVA-echo representing a true anatomic measurement. These findings have important implications for grading of aortic stenosis and management of patients with moderate to severe aortic stenosis.

Abstract 13770: DWS as an Index of Myocardial Stiffness and a Predictor of Heart Failure Outcome in Patients with Chronic Beta-blockade Therapy

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Yuko Soyama ◽  
Toshiaki Mano ◽  
Shinichi Hirotani ◽  
Mitsuru Masaki ◽  
Miho Fukui ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Wall Thickness ◽  
Posterior Wall ◽  
Left Ventricular ◽  
Beta Blockade ◽  
Myocardial Stiffness ◽  
Reduced Ejection Fraction ◽  
Posterior Wall Thickness ◽  
Diastolic Wall Strain

Background: Diastolic dysfunction determines symptoms and prognosis in patients with left ventricular (LV) dysfunction. Diastolic wall strain (DWS) is associated with poor outcomes in heart failure with preserved ejection fraction. However, the utility of DWS is still unknown in heart failure with reduced ejection fraction (HFrEF). Our aim is to determine whether DWS is predictive of the outcome in HFrEF. Methods: We studied 54 HFrEF patients (LVEF<50%) and followed DWS as an index of myocardial stiffness for 6 months after the induction of beta blockade (Bisoprolol 2.5-10 mg / day). DWS was determined in the LV M-mode echocardiogram using the following equation: DWS = {(LV posterior wall thickness at end-systole - LV posterior wall thickness at end-diastole) / LV posterior wall thickness at end-systole}. We followed for 7years after the induction of beta-blockade. Results: DWS increased after the induction of beta-blockade (0.32±0.11 vs 0.25±0.12,p<0.05). DcT, EF and E’ also increased after the induction of beta-blockade. HR at rest and log BNP decreased following beta blockade. Patients with DWS ≤ median (0.25) before the induction of beta-blockade had higher rate of HF hospitalization than those with DWS >median during 7 years (Log-rank p =0.025). DcT, EF, E’, HR at rest and log BNP before the induction of beta blockade were not significant predictors of HF outcome (Log-rank p=0.263, 0.504, 0.0796, 0.289 and 0.877) respectively. Conclusions: Induction of beta-blockade provided an improvement in DWS. DWS might be useful as an index of myocardial stiffness to predict the outcomes in HFrEF patients with chronic beta-blockade therapy.

Clinical and echocardiographic outcomes of patients with moderate to severe aortic stenosis and preserved, mid-range and reduced ejection fraction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Chew ◽  
N Ngiam ◽  
B.Y.Q Tan ◽  
C.H Sia ◽  
H.W Sim ◽  
...  
Keyword(s):  
Heart Failure ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Aortic Valve Area ◽  
Ventricular Ejection Fraction ◽  
All Cause Mortality

Abstract Background Left ventricular ejection fraction (EF) plays an important role in risk stratifying and guiding therapy for patients with aortic stenosis (AS). This study aims to describe the clinical and echocardiographic outcomes of AS patients with preserved (ASpEF), mid-range (ASmrEF) and reduced (ASrEF) EF. Methods 713 consecutive patients with index echocardiographic diagnosis of moderate-severe AS (aortic valve area &lt;1.5cm2) were allocated according to the EF into three groups: ASrEF (EF&lt;40%), ASmrEF (EF 40–50%), and ASpEF (EF&gt;50%). The study outcomes were defined as 5-year all-cause mortality, heart failure admissions, and aortic valve replacement (AVR). Results In comparison to patients with ASpEF, those with ASrEF were more frequently male, and systolic blood pressure was significantly lower on enrolment (p&lt;0.001). Diabetes, ischemic heart disease and atrial fibrillation were more commonly seen in the ASrEF and ASmrEF groups, compared to ASpEF group. All-cause mortality rates were 30.5% for ASpEF, 50.8% for ASmrEF, 55.0% for ASrEF groups (p&lt;0.001). Increased rates of heart failure admissions were seen in the ASmrEF and ASrEF groups (30.5% and 33.9%, respectively, vs. 14.9% in ASpEF group). Patients with ASrEF had significantly higher rates of AVR as compared to those in the ASmrEF and ASpEF groups (p=0.032). Conclusion Echocardiographic and clinical outcomes of ASmrEF patients resembled those of ASrEF more closely than the ASpEF patients. Stratifying AS patients according to the different EF groups may improve risk assessment and treatment strategies. Figure 1 Funding Acknowledgement Type of funding source: None

Abstract 5773: Reduced Left Ventricular Vortex Formation Ability Despite Preserved Ejection Fraction in Low-Flow, Low-Gradient Severe Aortic Stenosis

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Li Ching Lee ◽  
Sher Lynn Lim ◽  
Huay Cheem Tan ◽  
Boon Lock Chia ◽  
Kian Keong Poh
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Severe Aortic Stenosis ◽  
Vortex Formation ◽  
Left Ventricular ◽  
Low Flow ◽  
Aortic Valve Area ◽  
Stroke Work ◽  
Tei Index

Background and Aim : Low-flow, low-gradient (LFLG) severe aortic stenosis (AS) despite preserved left ventricular (LV) ejection fraction (EF) has been associated with more advanced stage of the disease, lower cardiac output (CO) and higher systemic afterload. We aim to characterize the LV performance determinants, including its vortex formation (VF) ability. Methods : Echocardiography was performed in 61 consecutive patients with severe AS (aortic valve area index (AVAI) ≤ 0.6 cm 2 /m 2 ) and preserved LVEF (≥ 50%). In addition to biplane LV measurements, AS severity indices and Tei index were measured. Hemodynamic indices (including systemic vascular resistance (SVR) and valvulo-arterial impedance (VAI)) were calculated. VF index (VFI) was obtained from 4 X (1-β)/πX α 3 X LVEF where β is the fraction of total transmitral diastolic stroke volume (SVol) contributed by atrial contraction (assessed by time velocity integral of the mitral E and A waves) and α is the end diastolic volume (EDV) 1/3 divided by mitral annular diameter during early diastole. Patients were categorized by their LV SVol index (SVI). LFLG group consisted of SVI < 45ml/m 2 . Results : Mean VFI was 2.67±1.1; AVAI, 0.50±0.09 cm 2 /m 2 . Though AVAI was slightly lower in LFLG, dimensionless index and aortic valve resistance were similar and associated with no difference in LV mass and volume between the 2 groups. VFI was significantly reduced in the LFLG, 2.37±0.9 vs 3.12±1.3 ( P =0.01), However other LV functional parameters including Tei index and LVEF were similar (Table ). LFLG was associated with higher SVR and VAI (Table ). In LFLG, the only significant correlates of VFI were SVR (r=0.38), VAI (0.37) and stroke work index (0.36); all P s<0.05. VFI did not correlate to these parameters in the non-LFLG group. Conclusion : In LFLG severe AS, increased afterload and suboptimal LV vortex formation ability contribute to lower CO/SV. VFI provides useful insights in understanding this relatively new entity. Comparison of echocardiographic and haemodynamic data in LFLG and non-LFLG groups

Take home messages with cases from focused update on echocardiographic assessment of aortic stenosis

Heart ◽  
2018 ◽  
Vol 104 (16) ◽  
pp. 1317-1322 ◽  
Author(s):  
Judy Hung ◽  
Sheila Liu Klassen ◽  
Javier Bermejo ◽  
John Boyd Chambers
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Classification Scheme ◽  
Severe Aortic Stenosis ◽  
Integrated Approach ◽  
Dobutamine Stress ◽  
Left Ventricular ◽  
Aortic Valve Area ◽  
American Society ◽  
Valve Area

Echocardiography plays an important role in the assessment of valvular aortic stenosis. Updated recommendations focusing on a stepwise approach to evaluating aortic stenosis have recently been published by the European Association of Cardiovascular Imaging and the American Society of Echocardiography. This review uses illustrative cases to demonstrate technical aspects of aortic stenosis assessment and use of the new proposed classification scheme for aortic stenosis. Key points from the updated recommendations reviewed in this paper are: (1) technical considerations and sources of error in measurement of peak velocity, mean aortic valve gradient and aortic valve area by continuity equation. (2) Application of flow status using indexed left ventricular stroke volume to distinguish patients with low gradients and a low calculated aortic valve area. (3) Use of low-dose dobutamine stress echocardiography in patients with low ejection fraction. (4) Application of the new classification scheme and review of algorithm use for echocardiographic evaluation of severe aortic stenosis. Improved understanding of how to handle unmatched variables and adopting an integrated approach to determine severity is central to guiding the clinician’s management of aortic stenosis.

scholarly journals Long-term outcome of congenital aortic valve stenosis: predictors of reintervention

2014 ◽  
Vol 25 (5) ◽  
pp. 893-902 ◽  
Author(s):  
Léa Hochstrasser ◽  
Patrick Ruchat ◽  
Nicole Sekarski ◽  
Michel Hurni ◽  
Ludwig K. von Segesser
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Posterior Wall ◽  
Left Ventricular ◽  
Post Intervention ◽  
Term Outcome ◽  
Congenital Aortic Stenosis ◽  
Long Term Outcome ◽  
Posterior Wall Thickness

AbstractObjectives:To evaluate long-term outcome of initial aortic valve intervention in a paediatric population with congenital aortic stenosis, and to determine risk factors associated with reintervention.Patients and methods:From 1985 to 2009, 77 patients with congenital aortic stenosis and a mean age of 5.8±5.6 years at diagnosis were followed up in our institution for 14.8±9.1 years.Results:First intervention was successful with 86% of patients having a residual peak aortic gradient <50 mmHg, and the proportion of patients with grade >1 regurgitation increased by 7%. Long-term survival after the first procedure was excellent, with 91% survival at 25 years. At a mean interval of 7.6±5.3 years, 30 patients required a reintervention (39%), mainly because of a recurrent aortic stenosis. Freedom from reintervention was 97, 89, 75, 53, and 42% at 1, 10, 15, 20, and 25 years, respectively. Predictors of reintervention were residual peak aortic gradient (p=0.0001), aortic regurgitation post-intervention >1 (p=0.02), prior balloon aortic valvuloplasty (p=0.04), and increased left ventricular posterior wall thickness (p=0.1).Conclusions:Aortic valve intervention is a safe and effective procedure for congenital aortic stenosis with excellent survival results. However, rate of reintervention is high and influenced by increased left ventricular posterior wall thickness pre-intervention, prior balloon valvuloplasty, higher residual peak systolic valve gradient, and more than mild regurgitation post-intervention. The study highlights that long-term follow-up is recommended for these patients.

Combination of Huangqi Granule and Rosuvastatin Improves the Cardiac Function in Heart Failure

2020 ◽  
Vol 19 (2) ◽  
pp. 181-187
Author(s):  
Jing Li ◽  
Yun Zhang ◽  
Weizhong Huangfu ◽  
Yuhong Ma
Keyword(s):  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Wall Thickness ◽  
Posterior Wall ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Model Group ◽  
Ventricular Ejection Fraction ◽  
Posterior Wall Thickness

Using rat models of heart failure, we evaluated the effects of rosuvastatin and Huangqi granule alone and in combination on left ventricular end-diastolic dimension, left ventricular end-systolic dimension, left ventricular ejection fraction, left ventricular posterior wall thickness at end-diastole, and left ventricular posterior wall thickness at end-systole. Results showed that left ventricular end-diastolic dimension, left ventricular end-systolic dimension in the rosuvastatin + Huangqi granule group were significantly decreased (P ‹ 0.01), while left ventricular ejection fraction, left ventricular posterior wall thickness at end-diastole and left ventricular posterior wall thickness at end-systole were significantly increased (P ‹ 0.05). The serum IL-2, IFN-β, and TNF-α in rosuvastatin + Huangqi granule group were significantly lower than those in model group (P ‹ 0.05). However, the levels of S-methylglutathione and superoxide dismutase in rosuvastatin + Huangqi granule group were significantly higher, while nitric oxide was significantly lower than that in the model group (P ‹ 0.05). Also, compared to the model group, the apoptosis rate, and the autophagy protein LC3-II in the cardiomyocytes of rosuvastatin + Huangqi granule group was significantly decreased (P ‹ 0.01), while the level of p62 protein was significantly increased (P ‹ 0.01). The levels of AMPK and p-AMPK in cardiomyocytes were significantly lower in rosuvastatin + Huangqi granule group; however, the levels of mTOR and p-mTOR showed an opposite trend (P ‹ 0.05). To sum up, rosuvastatin + Huangqi granule could improve the cardiac function, decrease the level of oxidative stress, and inflammatory cytokines in rats with HF. The possible underlying mechanism might be inhibition of autophagy and reduced apoptosis in cardiomyocytes by regulating AMPK-mTOR signaling pathway.

scholarly journals IMPULSE: the impact of gender on the presentation and management of aortic stenosis across Europe

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001443
Author(s):  
Richard Paul Steeds ◽  
David Messika-Zeitoun ◽  
Jeetendra Thambyrajah ◽  
Antonio Serra ◽  
Eberhard Schulz ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Surgical Aortic Valve Replacement ◽  
Ventricular Ejection Fraction ◽  
Patient Profile ◽  
Transcatheter Aortic Valve ◽  
The Impact

AimsThere is an increasing awareness of gender-related differences in patients with severe aortic stenosis and their outcomes after surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI).MethodsData from the IMPULSE registry were analysed. Patients with severe aortic stenosis (AS) were enrolled between March 2015 and April 2017 and stratified by gender. A subgroup analysis was performed to assess the impact of age.ResultsOverall, 2171 patients were enrolled, and 48.0% were female. Women were characterised by a higher rate of renal impairment (31.7 vs 23.3%; p<0.001), were at higher surgical risk (EuroSCORE II: 4.5 vs 3.6%; p=0.001) and more often in a critical preoperative state (7.0vs 4.2%; p=0.003). Men had an increased rate of previous cardiac surgery (9.4 vs 4.7%; p<0.001) and a reduced left ventricular ejection fraction (4.9 vs 1.3%; p<0.001). Concomitant mitral and tricuspid valve disease was substantially more common among women. Symptoms were highly prevalent in both women and men (83.6 vs 77.3%; p<0.001). AVR was planned in 1379 cases. Women were more frequently scheduled to undergo TAVI (49.3 vs 41.0%; p<0.001) and less frequently for SAVR (20.3 vs 27.5%; p<0.001).ConclusionsThe present data show that female patients with severe AS have a distinct patient profile and are managed in a different way to males. Gender-based differences in the management of patients with severe AS need to be taken into account more systematically to improve outcomes, especially for women.

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