Sex-differences in aortic stenosis: Effect on functional capacity and prognosis

Background: The patterns of left ventricular (LV) remodeling in aortic stenosis (AS) are different in men and women. We aimed to assess whether there were also sex differences in measurements obtained on exercise testing. Methods: Echocardiography and ETT (modified Bruce) were performed at presentation in 316 patients with moderate or severe AS. An early rapid rise in heart rate (RR-HR) during ETT was defined as achieving at least 85% of target heart rate or ≥50% increase from baseline within the first 6 min. Results: Mean age was 66 ± 12 years in men (n = 212) and 65 ± 12 years in women (n = 104) (p = NS). Men walked longer than women on the treadmill (10.4 ± 4.3 vs. 8.2 ± 4.2 min, p < 0.001) and achieved higher METs (9.2 ± 4.5 vs. 7.6 ± 4.3, p < 0.001), but both sexes achieved similar levels of peak heart rate and blood pressure. During a mean follow up of 34.9 ± 34.6 months, 29 deaths occurred (20 in men and 9 in women, p = 0.821). Age and body mass index were strong determinants of lower METs in men, but not in women, while Zva was a determinant in women but not in men. RR-HR was a strong determinant of lower METs in both sexes. Event-free survival was significantly lower in men with RR-HR but not in women. Conclusion: Exercise capacity was lower in women than men, and the determinants of exercise capacity differed. An RR-HR was a strong determinant of lower METs in both sexes, but predicted all-cause mortality only in men.