Stehli Julia, Zaman Sarah, Stähli Barbara E
Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
Front Cardiovasc Med. 2023 Aug 15;10:1256970. doi: 10.3389/fcvm.2023.1256970. eCollection 2023.
This review gives an overview of sex-based differences in aortic valve stenosis, spanning from pathophysiological mechanisms and disease progression, clinical presentation, presence of comorbidities, and diagnostic assessment, to treatment and outcomes. In particular, sex-related differences in the degree of aortic valve calcification, the response of the left ventricle to pressure overload, as well as in the referral to procedures, with women being less frequently referred for surgical aortic valve replacement and experiencing longer waiting times for transcatheter procedures, will be discussed. Sex-related differences are also particularly evident in outcomes of patients with severe aortic stenosis undergoing surgical or transcatheter procedures. The apparent sex paradox seen in women undergoing transcatheter aortic valve implantation refers to the phenomenon of women experiencing higher rates of short-term mortality and bleeding events, but demonstrating improved long-term survival as compared to men. Women who undergo surgical aortic valve replacement have generally worse outcomes as compared to men, which is reflected by the inclusion of female sex in surgical risk calculation scores. Hence, a thorough understanding of sex-related differences in aortic valve stenosis is important to provide optimal and personalized patient care.
本综述概述了主动脉瓣狭窄基于性别的差异，内容涵盖病理生理机制、疾病进展、临床表现、合并症的存在情况、诊断评估，以及治疗和预后。特别将讨论主动脉瓣钙化程度、左心室对压力超负荷的反应方面的性别差异，以及转诊至手术治疗方面的差异，女性较少被转诊进行外科主动脉瓣置换术，且接受经导管手术的等待时间更长。性别差异在接受外科或经导管手术的重度主动脉狭窄患者的预后中也尤为明显。在接受经导管主动脉瓣植入术的女性中出现的明显性别悖论是指，女性短期死亡率和出血事件发生率较高，但与男性相比，其长期生存率有所改善。接受外科主动脉瓣置换术的女性总体预后通常比男性更差，这体现在外科手术风险计算评分中纳入了女性性别因素。因此，深入了解主动脉瓣狭窄的性别差异对于提供最佳的个性化患者护理至关重要。
