Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Department of Cardiology, Huashan Hospital Fudan University, Shanghai, China.
Heart. 2020 Jul;106(13):970-976. doi: 10.1136/heartjnl-2019-315407. Epub 2020 Mar 22.
Aortic stenosis (AS) is a common valve disorder in an ageing population in western countries, and women, with longer life expectancy, comprise a substantial percentage of elderly patients with AS. Compared with men, women exhibit distinctive characteristics at the level of stenotic valve leaflets and subsequent compensatory responses of the left ventricle to chronic pressure overload, and in clinical presentation, consequences and response to intervention. Randomised controlled trials of transcatheter aortic valve implantation have yielded new evidence of sex differences in both short-term and long-term outcomes after intervention. A comprehensive knowledge of the existing evidence may inform our understanding of gender differences during assessment and treatment of patients with AS. In this paper, we review the available evidence regarding sex differences in AS in terms of symptoms, clinical presentation, anatomical differences and pathophysiological progression, management and outcomes after aortic valve replacement. Implications for further research are suggested.
主动脉瓣狭窄（AS）是西方国家老年人群中常见的瓣膜疾病，女性预期寿命较长，在患有 AS 的老年患者中占很大比例。与男性相比，女性在狭窄瓣膜叶水平和左心室对慢性压力超负荷的后续代偿反应方面具有独特的特征，并且在临床表现、后果和对干预的反应方面也存在差异。经导管主动脉瓣植入术的随机对照试验为干预后短期和长期结果的性别差异提供了新的证据。全面了解现有证据可以帮助我们了解在评估和治疗 AS 患者时的性别差异。本文回顾了 AS 中与症状、临床表现、解剖差异和病理生理进展、管理以及主动脉瓣置换术后结果相关的现有证据。并提出了进一步研究的意义。
