Does Gender Affect the Rates of Abnormal Exercise Stress Echocardiography in Patients with Asymptomatic Severe Aortic Stenosis?

Background and aim of the study: Patient gender can affect not only the clinical manifestations of coronary artery disease (CAD) but also the clinician’s interpretation of the symptoms and results of exercise stress tests for management decisions. This may be true also for aortic stenosis (AS), given its many shared features with CAD and similar symptom-based management. The study aim was to evaluate the effect of gender on the assessment of severe asymptomatic AS by exercise stress echocardiography (ESE).
Methods: A total of 160 patients (89 males, 71 females) with severe asymptomatic AS and good left ventricular function underwent ESE for assessment of their clinical status. Of these patients, 133 (83%) were followed up after echocardiography for a mean of 644 ± 467 days. The findings and outcome were compared between males and females.

Results: No gender-related differences were identified for mean age, baseline and peak exercise heart rates and blood pressures, aortic valve area, and prevalence of CAD. Female patients had a lower exercise capacity (shorter exercise time, lower exercise load), but there were no significant between-group differences in the exercise-related parameters defining AS. In total, 38 women (24%) and 45 men (28%) were treated by aortic valve replacement (p = 0.2) within a similar time range from echocardiography (p = 0.6).
Conclusion: Asymptomatic women with severe AS have similar rates of abnormal ESE as men, despite limitations in exercise capacity among women compared to men.

The Journal of Heart Valve Disease 2012;21:31-36