Longitudinal Outcomes of Patients with Aortic Stenosis Stratified by Sex: An Asian Perspective
Background: Severe aortic stenosis (AS) stratified by sex has been increasingly studied in the European population. Sex-specific outcomes in Asian patients with AS remain poorly defined. Hence, we aimed to study the clinical characteristics and impact of sex in moderate-to-severe AS, undergoing both...
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MDPI AG
2025-01-01
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| Series: | Journal of Cardiovascular Development and Disease |
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| Online Access: | https://www.mdpi.com/2308-3425/12/1/32 |
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| author | Joy Y. S. Ong Aloysius S. T. Leow Chun Yi Ng Poay Huan Loh Swee Chye Quek William K. F. Kong Tiong Cheng Yeo Ching Hui Sia Kian Keong Poh |
| author_facet | Joy Y. S. Ong Aloysius S. T. Leow Chun Yi Ng Poay Huan Loh Swee Chye Quek William K. F. Kong Tiong Cheng Yeo Ching Hui Sia Kian Keong Poh |
| author_sort | Joy Y. S. Ong |
| collection | DOAJ |
| description | Background: Severe aortic stenosis (AS) stratified by sex has been increasingly studied in the European population. Sex-specific outcomes in Asian patients with AS remain poorly defined. Hence, we aimed to study the clinical characteristics and impact of sex in moderate-to-severe AS, undergoing both invasive and conservative interventions in an Asian cohort over 10 years. Methods: Consecutive data with echocardiographic diagnoses of AS were stratified according to gender in a tertiary academic center between 2011 and 2021. Demographics, comorbidities, and clinical outcomes were compared. Results: Seven hundred and three (703) patients were included (56%, <i>n</i> = 397 were female). Calcific AS was the dominant etiology in both genders. Females had higher incidences of anemia (<i>p</i> < 0.001) and chronic kidney disease (<i>p</i> = 0.026); although, females had lower incidences of cardiovascular complications of coronary artery disease (CAD) (<i>p</i> = 0.002) and prior acute myocardial infarction (AMI) (<i>p</i> = 0.015). Echocardiographically, females had a smaller left ventricular outflow tract diameter (LVOTd) (<i>p</i> < 0.001), LV mass (<i>p</i> < 0.001), and left ventricle end diastolic volume (LVEDV) (<i>p</i> < 0.001). Conversely, the left atrial (LA) area (<i>p</i> < 0.001) and volume index (LAVI) (<i>p</i> < 0.001) were larger in females. Females had higher average E/e’ (<i>p</i> = 0.010) ratios compared to males. The mean follow-up duration between genders was 4.1 ± 3.3 years. Upon univariate analysis, a greater proportion of female AS patients encountered cardiovascular (CV) hospitalization during follow-up (female: 27.5%, <i>n</i> = 109 vs. male: 18.3%, <i>n</i> = 56; <i>p</i> = 0.005) compared to male patients, but there were no significant differences for the outcomes of heart failure (<i>p</i> = 0.612), stroke (<i>p</i> = 0.664), and all-cause mortality (<i>p</i> = 0.827). Fewer females underwent aortic valve (AV) intervention compared to males (21.2% vs. 27.8%, <i>p</i> = 0.042), albeit with a longer duration to AV intervention (3.6 years ± 2.4 vs. 2.6 years ± 2.3, <i>p</i> = 0.016). In the severe AS cohort, female sex remained an independent predictor for subsequent heart failure (aHR 2.89, 95% CI 1.01–8.29, <i>p</i> = 0.048) and CV hospitalization (aHR 20.0, 95% CI 1.19–335, <i>p</i> = 0.037) after adjustments for age, ethnicity, body mass index (BMI), comorbidities, left ventricular ejection fraction (LVEF), and AV intervention. Conclusions: There was no difference in heart failure, stroke, and all-cause mortality outcomes between male and female Asian patients with moderate-to-severe AS. However, there were more cardiovascular hospitalizations, with fewer and longer duration to AV intervention in females compared to males in our cohort. |
| format | Article |
| id | doaj-art-6965acfe4fe6493aba62a8b862e04b45 |
| institution | Kabale University |
| issn | 2308-3425 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | MDPI AG |
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| series | Journal of Cardiovascular Development and Disease |
| spelling | doaj-art-6965acfe4fe6493aba62a8b862e04b452025-01-24T13:36:03ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252025-01-011213210.3390/jcdd12010032Longitudinal Outcomes of Patients with Aortic Stenosis Stratified by Sex: An Asian PerspectiveJoy Y. S. Ong0Aloysius S. T. Leow1Chun Yi Ng2Poay Huan Loh3Swee Chye Quek4William K. F. Kong5Tiong Cheng Yeo6Ching Hui Sia7Kian Keong Poh8Department of Cardiology, National University Heart Centre Singapore, 5 Lower Kent Ridge Road, Singapore 119074, SingaporeDepartment of Medicine, National University Hospital, Level 10, NUHS Tower Block 1 Kent Ridge Road, Singapore 119228, SingaporeDepartment of Cardiology, National University Heart Centre Singapore, 5 Lower Kent Ridge Road, Singapore 119074, SingaporeDepartment of Cardiology, National University Heart Centre Singapore, 5 Lower Kent Ridge Road, Singapore 119074, SingaporeDepartment of Medicine, Yong Loo Lin School of Medicine, National University of Singapore Level 11, NUHS Tower Block 1E Kent Ridge Road, Singapore 119228, SingaporeDepartment of Cardiology, National University Heart Centre Singapore, 5 Lower Kent Ridge Road, Singapore 119074, SingaporeDepartment of Cardiology, National University Heart Centre Singapore, 5 Lower Kent Ridge Road, Singapore 119074, SingaporeDepartment of Cardiology, National University Heart Centre Singapore, 5 Lower Kent Ridge Road, Singapore 119074, SingaporeDepartment of Cardiology, National University Heart Centre Singapore, 5 Lower Kent Ridge Road, Singapore 119074, SingaporeBackground: Severe aortic stenosis (AS) stratified by sex has been increasingly studied in the European population. Sex-specific outcomes in Asian patients with AS remain poorly defined. Hence, we aimed to study the clinical characteristics and impact of sex in moderate-to-severe AS, undergoing both invasive and conservative interventions in an Asian cohort over 10 years. Methods: Consecutive data with echocardiographic diagnoses of AS were stratified according to gender in a tertiary academic center between 2011 and 2021. Demographics, comorbidities, and clinical outcomes were compared. Results: Seven hundred and three (703) patients were included (56%, <i>n</i> = 397 were female). Calcific AS was the dominant etiology in both genders. Females had higher incidences of anemia (<i>p</i> < 0.001) and chronic kidney disease (<i>p</i> = 0.026); although, females had lower incidences of cardiovascular complications of coronary artery disease (CAD) (<i>p</i> = 0.002) and prior acute myocardial infarction (AMI) (<i>p</i> = 0.015). Echocardiographically, females had a smaller left ventricular outflow tract diameter (LVOTd) (<i>p</i> < 0.001), LV mass (<i>p</i> < 0.001), and left ventricle end diastolic volume (LVEDV) (<i>p</i> < 0.001). Conversely, the left atrial (LA) area (<i>p</i> < 0.001) and volume index (LAVI) (<i>p</i> < 0.001) were larger in females. Females had higher average E/e’ (<i>p</i> = 0.010) ratios compared to males. The mean follow-up duration between genders was 4.1 ± 3.3 years. Upon univariate analysis, a greater proportion of female AS patients encountered cardiovascular (CV) hospitalization during follow-up (female: 27.5%, <i>n</i> = 109 vs. male: 18.3%, <i>n</i> = 56; <i>p</i> = 0.005) compared to male patients, but there were no significant differences for the outcomes of heart failure (<i>p</i> = 0.612), stroke (<i>p</i> = 0.664), and all-cause mortality (<i>p</i> = 0.827). Fewer females underwent aortic valve (AV) intervention compared to males (21.2% vs. 27.8%, <i>p</i> = 0.042), albeit with a longer duration to AV intervention (3.6 years ± 2.4 vs. 2.6 years ± 2.3, <i>p</i> = 0.016). In the severe AS cohort, female sex remained an independent predictor for subsequent heart failure (aHR 2.89, 95% CI 1.01–8.29, <i>p</i> = 0.048) and CV hospitalization (aHR 20.0, 95% CI 1.19–335, <i>p</i> = 0.037) after adjustments for age, ethnicity, body mass index (BMI), comorbidities, left ventricular ejection fraction (LVEF), and AV intervention. Conclusions: There was no difference in heart failure, stroke, and all-cause mortality outcomes between male and female Asian patients with moderate-to-severe AS. However, there were more cardiovascular hospitalizations, with fewer and longer duration to AV intervention in females compared to males in our cohort.https://www.mdpi.com/2308-3425/12/1/32aortic stenosissex differencesAsian populationclinical outcomes |
| spellingShingle | Joy Y. S. Ong Aloysius S. T. Leow Chun Yi Ng Poay Huan Loh Swee Chye Quek William K. F. Kong Tiong Cheng Yeo Ching Hui Sia Kian Keong Poh Longitudinal Outcomes of Patients with Aortic Stenosis Stratified by Sex: An Asian Perspective Journal of Cardiovascular Development and Disease aortic stenosis sex differences Asian population clinical outcomes |
| title | Longitudinal Outcomes of Patients with Aortic Stenosis Stratified by Sex: An Asian Perspective |
| title_full | Longitudinal Outcomes of Patients with Aortic Stenosis Stratified by Sex: An Asian Perspective |
| title_fullStr | Longitudinal Outcomes of Patients with Aortic Stenosis Stratified by Sex: An Asian Perspective |
| title_full_unstemmed | Longitudinal Outcomes of Patients with Aortic Stenosis Stratified by Sex: An Asian Perspective |
| title_short | Longitudinal Outcomes of Patients with Aortic Stenosis Stratified by Sex: An Asian Perspective |
| title_sort | longitudinal outcomes of patients with aortic stenosis stratified by sex an asian perspective |
| topic | aortic stenosis sex differences Asian population clinical outcomes |
| url | https://www.mdpi.com/2308-3425/12/1/32 |
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