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Sex differences in aortic stenosis: Identification of knowledge gaps for sex-specific personalized medicine

OBJECTIVES: This review summarizes sex-based differences in aortic stenosis (AS) and identifies knowledge gaps that should be addressed by future studies. BACKGROUND: AS is the most common valvular heart disease in developed countries. Sex-specific differences have not been fully appreciated, as a r...

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Autores principales: Iribarren, Ana C., AlBadri, Ahmed, Wei, Janet, Nelson, Michael D., Li, Debiao, Makkar, Raj, Merz, C. Noel Bairey
Formato: Online Artículo Texto
Lenguaje:English
Publicado: 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9629620/
https://www.ncbi.nlm.nih.gov/pubmed/36330169
http://dx.doi.org/10.1016/j.ahjo.2022.100197
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author Iribarren, Ana C.
AlBadri, Ahmed
Wei, Janet
Nelson, Michael D.
Li, Debiao
Makkar, Raj
Merz, C. Noel Bairey
author_facet Iribarren, Ana C.
AlBadri, Ahmed
Wei, Janet
Nelson, Michael D.
Li, Debiao
Makkar, Raj
Merz, C. Noel Bairey
author_sort Iribarren, Ana C.
collection PubMed
description OBJECTIVES: This review summarizes sex-based differences in aortic stenosis (AS) and identifies knowledge gaps that should be addressed by future studies. BACKGROUND: AS is the most common valvular heart disease in developed countries. Sex-specific differences have not been fully appreciated, as a result of widespread under diagnosis of AS in women. SUMMARY: Studies including sex-stratified analyses have shown differences in pathophysiology with less calcification and more fibrosis in women’s aortic valve. Women have impaired myocardial perfusion reserve and different compensatory response of the left ventricle (LV) to pressure overload, with concentric remodeling and more diffuse fibrosis, in contrast to men with more focal fibrosis and more dilated/eccentrically remodeled LV. There is sex difference in clinical presentation and anatomical characteristics, with women having more paradoxical low-flow/low-gradient AS, under-diagnosis and severity underestimated, with less referral to aortic valve replacement (AVR) compared to men. The response to therapies is also different: women have more adverse events with surgical AVR and greater survival benefit with transcatheter AVR. After AVR, women would have more favorable LV remodeling, but sex-related differences in changes in myocardial reserve flow need future research. CONCLUSIONS: Investigation into these described sex-related differences in AS offers potential utility for improving prevention and treatment of AS in women and men. To better understand sex-based differences in pathophysiology, clinical presentation, and response to therapies, sex-specific critical knowledge gaps should be addressed in future research for sex-specific personalized medicine.
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spelling pubmed-96296202022-11-02 Sex differences in aortic stenosis: Identification of knowledge gaps for sex-specific personalized medicine Iribarren, Ana C. AlBadri, Ahmed Wei, Janet Nelson, Michael D. Li, Debiao Makkar, Raj Merz, C. Noel Bairey Am Heart J Plus Article OBJECTIVES: This review summarizes sex-based differences in aortic stenosis (AS) and identifies knowledge gaps that should be addressed by future studies. BACKGROUND: AS is the most common valvular heart disease in developed countries. Sex-specific differences have not been fully appreciated, as a result of widespread under diagnosis of AS in women. SUMMARY: Studies including sex-stratified analyses have shown differences in pathophysiology with less calcification and more fibrosis in women’s aortic valve. Women have impaired myocardial perfusion reserve and different compensatory response of the left ventricle (LV) to pressure overload, with concentric remodeling and more diffuse fibrosis, in contrast to men with more focal fibrosis and more dilated/eccentrically remodeled LV. There is sex difference in clinical presentation and anatomical characteristics, with women having more paradoxical low-flow/low-gradient AS, under-diagnosis and severity underestimated, with less referral to aortic valve replacement (AVR) compared to men. The response to therapies is also different: women have more adverse events with surgical AVR and greater survival benefit with transcatheter AVR. After AVR, women would have more favorable LV remodeling, but sex-related differences in changes in myocardial reserve flow need future research. CONCLUSIONS: Investigation into these described sex-related differences in AS offers potential utility for improving prevention and treatment of AS in women and men. To better understand sex-based differences in pathophysiology, clinical presentation, and response to therapies, sex-specific critical knowledge gaps should be addressed in future research for sex-specific personalized medicine. 2022-09 2022-08-25 /pmc/articles/PMC9629620/ /pubmed/36330169 http://dx.doi.org/10.1016/j.ahjo.2022.100197 Text en https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) ).
spellingShingle Article
Iribarren, Ana C.
AlBadri, Ahmed
Wei, Janet
Nelson, Michael D.
Li, Debiao
Makkar, Raj
Merz, C. Noel Bairey
Sex differences in aortic stenosis: Identification of knowledge gaps for sex-specific personalized medicine
title Sex differences in aortic stenosis: Identification of knowledge gaps for sex-specific personalized medicine
title_full Sex differences in aortic stenosis: Identification of knowledge gaps for sex-specific personalized medicine
title_fullStr Sex differences in aortic stenosis: Identification of knowledge gaps for sex-specific personalized medicine
title_full_unstemmed Sex differences in aortic stenosis: Identification of knowledge gaps for sex-specific personalized medicine
title_short Sex differences in aortic stenosis: Identification of knowledge gaps for sex-specific personalized medicine
title_sort sex differences in aortic stenosis: identification of knowledge gaps for sex-specific personalized medicine
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9629620/
https://www.ncbi.nlm.nih.gov/pubmed/36330169
http://dx.doi.org/10.1016/j.ahjo.2022.100197
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