Background Aortic stenosis (AS) is the most common valvular heart disease in developed countries. Sex differences have been described in AS pathophysiology and left ventricular (LV) remodelling, as well as clinical presentation and response to therapies (1). However, sex differences in LV function parameters, namely global longitudinal strain (GLS), have been scarcely explored so far. Purpose To investigate sex differences, taking into account GLS, in patients with severe AS referred to surgical aortic valve replacement (SAVR). Methods The study population was from a single centre, prospective registry of patients with severe native valve AS who were referred for SAVR between June 2020 to October 2022. Severe AS was defined by standard guideline criteria (2). All patients underwent an echocardiogram immediately before and at least 3 months after surgery. Results Table 1 recapitulates sex differences in our population (n=119, 43% women). No differences in age or cardiovascular (CV) risk factors were noted. Clinical presentation and AS etiology were also similar. At baseline, women had lower EuroSCORE (p=0.039), creatinine (p <0.001), and haemoglobin levels (p=0.001). The echocardiogram showed a higher mean aortic valve gradient in women (Gmean, 62 vs. 50 mmHg, p=0.002). Women also had higher relative wall thickness (RWT, 0.49 vs. 0.42, p=0.037), despite lower LV mass index (124.9 vs. 136.6 g/m², p=0.037). Regarding LV function, women showed higher EF (64% vs. 60%, p=0.002) and GLS (16.5% vs. 14.6%, p=0.006) values. This is partially explained by the higher prevalence of concomitant coronary artery disease (CAD) in men, more frequently subjected to a concomitant coronary artery bypass graft than women (CABG, 38% vs. 8%, p <0.001). Post-operative complications had similar rates in men and women. After a median follow-up of 16 (6-18) months, death from any cause (6.0% vs. 1.5%, p=0.186) and rehospitalization for CV causes (14.0% vs. 4.0%, p=0.055) tended to be more frequent among women. When considering patients with severe AS alone (n=89), women had higher Gmean (64 vs. 53 mmHg, p=0.035) and EF (65% vs. 62%, p=0.045) but similar GLS (16.9% vs. 16.6%, p=0.230) as compared to men (Figure 2). At follow-up, EF and GLS failed to improve in both sexes and no differences were noted between women and men (EF 60% vs. 60%, p=0.476; GLS 15.9% vs. 16.0%, p=0.976). Conclusions In a population of all-comers patients with severe AS undergoing SAVR, women showed higher Gmean, EF, and GLS values. This is partially due to the higher prevalence of a concomitant CAD in men. When considering patients with AS alone, women still had higher EF and Gmean than men, despite a similar GLS. Future larger prospective studies with longer follow-up are needed in order to further characterize such differences and correlate them with specific outcomes.

中文翻译：

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接受手术置换的严重主动脉瓣狭窄的性别差异


背景 主动脉瓣狭窄 （AS） 是发达国家最常见的瓣膜性心脏病。性别差异已在 AS 病理生理学和左心室 （LV） 重塑以及临床表现和对治疗的反应中进行了描述 （1）。然而，到目前为止，LV 功能参数的性别差异，即整体纵向应变 （GLS），几乎没有被探索。目的 研究转诊至外科主动脉瓣置换术 （SAVR） 的严重 AS 患者的性别差异，同时考虑到 GLS。方法 研究人群来自 2020 年 6 月至 2022 年 10 月期间转诊接受 SAVR 的严重自体瓣膜 AS 患者的单一中心前瞻性登记。重度 AS 由标准指南标准 （2） 定义。所有患者在手术前和手术后至少 3 个月接受了超声心动图检查。结果 表 1 概括了我们人群的性别差异 （n=119,43% 女性）。未发现年龄或心血管 （CV） 危险因素的差异。临床表现和 AS 病因也相似。基线时，女性的 EuroSCORE （p=0.039） 、肌酐 （p <0.001） 和血红蛋白水平 （p=0.001） 较低。超声心动图显示女性平均主动脉瓣梯度较高 （Gmean，62 vs. 50 mmHg，p=0.002）。尽管 LV 质量指数较低 （124.9 vs. 136.6 g/m²，p=0.037），但女性的相对壁厚也较高 （RWT，0.49 vs. 0.42，p=0.037）。关于 LV 功能，女性表现出更高的 EF （64% vs. 60%，p=0.002） 和 GLS （16.5% vs. 14.6%，p=0.006） 值。这在一定程度上是由于男性伴随冠状动脉疾病 （CAD） 的患病率更高，与女性相比，伴随冠状动脉旁路移植术的频率更高（CABG，38% 对 8%，p <0.001）。 男性和女性术后并发症的发生率相似。中位随访 16 （6-18） 个月后，全因死亡 （6.0% vs. 1.5%，p=0.186） 和因 CV 原因再住院 （14.0% vs. 4.0%，p=0.055） 在女性中往往更常见。当考虑单独患有严重 AS 的患者 （n=89） 时，与男性相比，女性的 Gmean （64 vs. 53 mmHg，p=0.035） 和 EF （65% vs. 62%，p=0.045） 但相似 GLS （16.9% vs. 16.6%，p=0.230） 与男性相比（图 2）。在随访中，EF 和 GLS 在两性中均未改善，女性和男性之间没有差异 （EF 60% vs. 60%，p=0.476;GLS 15.9% 对 16.0%，p=0.976）。结论 在接受 SAVR 的重症 AS 患者群体中，女性表现出较高的 Gmean 、 EF 和 GLS 值。这部分是由于男性伴随 CAD 的患病率较高。当考虑单独的 AS 患者时，尽管 GLS 相似，但女性的 EF 和 Gmean 仍然高于男性。未来需要更大规模的前瞻性研究和更长的随访时间，以进一步描述这种差异并将其与特定结局相关联。