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Review

Sex Differences in Aortic Stenosis: From the Pathophysiology to the Intervention, Current Challenges, and Future Perspectives

by
Paolo Springhetti
1,2,
Kathia Abdoun
1 and
Marie-Annick Clavel
1,*
1
Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC G1V 4G5, Canada
2
Department of Medicine, Division of Cardiology, University of Verona, 37129 Verona, Italy
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2024, 13(14), 4237; https://doi.org/10.3390/jcm13144237
Submission received: 24 June 2024 / Revised: 16 July 2024 / Accepted: 17 July 2024 / Published: 19 July 2024

Abstract

Calcific aortic stenosis (AS) is a major cause of morbidity and mortality in high-income countries. AS presents sex-specific features impacting pathophysiology, outcomes, and management strategies. In women, AS often manifests with a high valvular fibrotic burden, small valvular annuli, concentric left ventricular (LV) remodeling/hypertrophy, and, frequently, supernormal LV ejection fraction coupled with diastolic dysfunction. Paradoxical low-flow low-gradient AS epitomizes these traits, posing significant challenges post-aortic valve replacement due to limited positive remodeling and significant risk of patient–prosthesis mismatch. Conversely, men present more commonly with LV dilatation and dysfunction, indicating the phenotype of classical low-flow low-gradient AS, i.e., with decreased LV ejection fraction. However, these distinctions have not been fully incorporated into guidelines for AS management. The only treatment for AS is aortic valve replacement; women are frequently referred late, leading to increased heart damage caused by AS. Therefore, it is important to reassess surgical planning and timing to minimize irreversible cardiac damage in women. The integrity and the consideration of sex differences in the management of AS is critical. Further research, including sufficient representation of women, is needed to investigate these differences and to develop individualized, sex-specific management strategies.
Keywords: aortic stenosis; sex differences; diagnosis; complications; outcomes; aortic valve replacement; patient–prosthesis mismatch aortic stenosis; sex differences; diagnosis; complications; outcomes; aortic valve replacement; patient–prosthesis mismatch

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MDPI and ACS Style

Springhetti, P.; Abdoun, K.; Clavel, M.-A. Sex Differences in Aortic Stenosis: From the Pathophysiology to the Intervention, Current Challenges, and Future Perspectives. J. Clin. Med. 2024, 13, 4237. https://doi.org/10.3390/jcm13144237

AMA Style

Springhetti P, Abdoun K, Clavel M-A. Sex Differences in Aortic Stenosis: From the Pathophysiology to the Intervention, Current Challenges, and Future Perspectives. Journal of Clinical Medicine. 2024; 13(14):4237. https://doi.org/10.3390/jcm13144237

Chicago/Turabian Style

Springhetti, Paolo, Kathia Abdoun, and Marie-Annick Clavel. 2024. "Sex Differences in Aortic Stenosis: From the Pathophysiology to the Intervention, Current Challenges, and Future Perspectives" Journal of Clinical Medicine 13, no. 14: 4237. https://doi.org/10.3390/jcm13144237

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