Assessment and treatment of aortic stenosis in the contemporary era: focus on gender differences

Résumé fourni par la source

Aortic stenosis (AS) is a progressive valvular disease with increasing prevalence in aging populations, and its assessment and management have evolved significantly with the advent of transcatheter aortic valve implantation (TAVI). However, growing evidence highlights critical gender-based differences in disease presentation, diagnostic evaluation, and treatment outcomes. Women with AS tend to present at an older age, with more preserved left ventricular ejection fraction and concentric hypertrophy, often leading to underestimation of disease severity. They are also more likely to exhibit heart failure symptoms despite smaller valve areas. Imaging modalities, particularly echocardiography and computed tomography, must account for these sex-specific anatomical and physiological differences to avoid misclassification. In terms of treatment, women have historically been underrepresented in surgical aortic valve replacement (SAVR) trials, but more recent TAVI studies have included greater female participation. Although women undergoing TAVI exhibit higher periprocedural complication rates (e.g., vascular injury), they often experience better long-term survival compared to men, potentially due to lower rates of comorbidities such as coronary artery disease. Despite these advantages, disparities in referral patterns and delayed treatment persist. Tailoring diagnostic thresholds, improving representation in clinical trials, and enhancing awareness of gender-specific disease features are essential to optimizing outcomes. Future research should prioritize personalized approaches and integrate sex-specific risk stratification models to address these disparities. Understanding gender differences is vital to delivering equitable and effective care in the modern management of aortic stenosis.

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