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Sex Differences in the Clinical Recognition of Significant Aortic Stenosis

Year: 2025

Type: article

Abstract: BACKGROUND: Women with significant aortic stenosis (AS) are under-represented among patients undergoing aortic valve replacement in the United States as compared with men despite similar disease prevalence. OBJECTIVES: This study evaluated the impact of sex on the clinical recognition of significant AS following diagnostic transthoracic echocardiogram (TTE). METHODS: Using data from a large administrative multicenter database, we assessed rates of clinical diagnosis of AS defined by assignment of an Internal Classification Diagnosis (ICD) code for AS following a diagnostic TTE. Fine-Gray models were used to evaluate the 1-year cumulative rate of AS diagnosis by sex, AS severity, and AS phenotype accounting for competing risk of death. RESULTS: Among 2,036 included patients (48.9% female, 51.1% male), the 1-year rate of clinical recognition following a diagnostic TTE with at least moderate AS was low (52.4%), and women were less likely as compared with men to receive a clinical diagnosis of AS (55.7% male vs 48.9% female; P = 0.003). Specifically, among patients with severe AS, women were less likely to receive an ICD diagnosis as compared with males (64.1% vs 74.3%), driven primarily by lower rates of clinical recognition of severe low gradient AS (66.9% male vs 54.3% female; P = 0.004). CONCLUSIONS: Rates of clinical recognition of AS following a diagnostic TTE are low, and vary significantly by sex, AS disease severity, and severe AS phenotype. Further studies are needed to maximize the clinical recognition of TTE-confirmed AS and to mitigate sex disparities in diagnosis and treatment.

Source: JACC Advances

DOI: 10.1016/j.jacadv.2025.102370

Authors: Daniela Crousillat, Dayana Shariff, Rong Duan, Varsha Tanguturi, Sammy Elmariah

Institutions: University of South Florida, University of California, San Francisco, Massachusetts General Hospital, University of California San Francisco Medical Center

Language: English

Topic: Cardiac Valve Diseases and Treatments

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDGs: Good health and well-being, Reduced inequalities

Open Access status: gold

Estimated APC paid: $2,936