Women With Moderate or Severe Aortic Stenosis by Aortic Valve Area Are Disproportionately Classified With Normal‐Flow Low‐Gradient Aortic Stenosis and Assigned Lower Severity Grades Than Men
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| Natura: | Artículo Open Access |
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Wiley
2025
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| _version_ | 1867021829575540736 |
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| author | Christopher Sidwell Anna Curtis Theodore Kolias Andrew Harris Megan Joseph Troy LaBounty |
| author_facet | Christopher Sidwell Anna Curtis Theodore Kolias Andrew Harris Megan Joseph Troy LaBounty Christopher Sidwell Anna Curtis Theodore Kolias Andrew Harris Megan Joseph Troy LaBounty |
| collection | Wiley Open Access |
| contents | Women With Moderate or Severe Aortic Stenosis by Aortic Valve Area Are Disproportionately Classified With Normal‐Flow Low‐Gradient Aortic Stenosis and Assigned Lower Severity Grades Than Men Christopher Sidwell Anna Curtis Theodore Kolias Andrew Harris Megan Joseph Troy LaBounty Echocardiography ABSTRACT Purpose Patients with aortic stenosis (AS) may have discordant severity grades between AS by aortic valve area (AS AVA ) and AS using hemodynamic‐based guidelines (AS GL ). Individuals with normal left ventricular function and normal‐flow low‐gradient (NF‐LG) AS that is moderate or severe by AVA are downgraded in severity by current guidelines. We evaluated the prevalence and risk of NF‐LG AS in patients with moderate or severe AS AVA . Methods We compared the prevalence and mortality of NF‐LG AS and low‐flow low‐gradient (LF‐LG) AS compared to normal‐flow high‐gradient (NF‐HG) AS in patients with moderate and severe AS AVA and normal left ventricular function. Results Among 5360 patients, 2974 had moderate AS AVA and 2386 had severe AS AVA (mean age 73.3 ± 12.8 years; 49.3% female; 1637 deaths over median of 4.2 years). In moderate AS AVA , women were more frequently classified as NF‐LG AS, with AS severity downgraded to mild using guidelines (52.0% women vs. 29.1% men, p < 0.001). In severe AS AVA , women were also more likely to have NF‐LG AS and be classified as mild or moderate AS using guidelines (23.9% women vs. 14.4% men, p < 0.001). Patients with NF‐LG moderate or severe AS AVA had comparable mortality to NF‐HG AS ( p > 0.05 for each). Conclusion Women with moderate or severe AS AVA have markedly higher rates of NF‐LG AS than men and are more likely to be assigned a lower AS severity grade based on current guidelines, despite mortality similar to NF‐HG AS. Discordance in AS severity between AS AVA and AS GL is common in both genders, although more common in women. 10.1111/echo.70270 http://creativecommons.org/licenses/by/4.0/ |
| doi_str_mv | 10.1111/echo.70270 |
| format | Artículo Open Access |
| id | wiley_oa_10_1111_echo_70270 |
| institution | Wiley Open Access |
| license_str_mv | http://creativecommons.org/licenses/by/4.0/ |
| publishDate | 2025 |
| publisher | Wiley |
| record_format | wiley_oa |
| spellingShingle | Women With Moderate or Severe Aortic Stenosis by Aortic Valve Area Are Disproportionately Classified With Normal‐Flow Low‐Gradient Aortic Stenosis and Assigned Lower Severity Grades Than Men Christopher Sidwell Anna Curtis Theodore Kolias Andrew Harris Megan Joseph Troy LaBounty Echocardiography Women With Moderate or Severe Aortic Stenosis by Aortic Valve Area Are Disproportionately Classified With Normal‐Flow Low‐Gradient Aortic Stenosis and Assigned Lower Severity Grades Than Men Christopher Sidwell Anna Curtis Theodore Kolias Andrew Harris Megan Joseph Troy LaBounty Echocardiography ABSTRACT Purpose Patients with aortic stenosis (AS) may have discordant severity grades between AS by aortic valve area (AS AVA ) and AS using hemodynamic‐based guidelines (AS GL ). Individuals with normal left ventricular function and normal‐flow low‐gradient (NF‐LG) AS that is moderate or severe by AVA are downgraded in severity by current guidelines. We evaluated the prevalence and risk of NF‐LG AS in patients with moderate or severe AS AVA . Methods We compared the prevalence and mortality of NF‐LG AS and low‐flow low‐gradient (LF‐LG) AS compared to normal‐flow high‐gradient (NF‐HG) AS in patients with moderate and severe AS AVA and normal left ventricular function. Results Among 5360 patients, 2974 had moderate AS AVA and 2386 had severe AS AVA (mean age 73.3 ± 12.8 years; 49.3% female; 1637 deaths over median of 4.2 years). In moderate AS AVA , women were more frequently classified as NF‐LG AS, with AS severity downgraded to mild using guidelines (52.0% women vs. 29.1% men, p < 0.001). In severe AS AVA , women were also more likely to have NF‐LG AS and be classified as mild or moderate AS using guidelines (23.9% women vs. 14.4% men, p < 0.001). Patients with NF‐LG moderate or severe AS AVA had comparable mortality to NF‐HG AS ( p > 0.05 for each). Conclusion Women with moderate or severe AS AVA have markedly higher rates of NF‐LG AS than men and are more likely to be assigned a lower AS severity grade based on current guidelines, despite mortality similar to NF‐HG AS. Discordance in AS severity between AS AVA and AS GL is common in both genders, although more common in women. 10.1111/echo.70270 http://creativecommons.org/licenses/by/4.0/ |
| title | Women With Moderate or Severe Aortic Stenosis by Aortic Valve Area Are Disproportionately Classified With Normal‐Flow Low‐Gradient Aortic Stenosis and Assigned Lower Severity Grades Than Men |
| topic | Echocardiography |
| url | https://onlinelibrary.wiley.com/doi/10.1111/echo.70270 |