Late-Breaking Science: Does sex matter in valvular heart disease?
31 Aug 2024
Late-Breaking Science In a Late-Breaking Science session yesterday, Professor Julia Mascherbauer (University Hospital St. Polten - St. Polten, Austria) presented results from the ESC’s EURObservational Research Programme (EORP) Valvular Heart Disease (VHD) II survey assessing sex differences in disease characteristics and treatment.
This analysis of the ESC EORP VHD II survey1 included 5,219 patients with severe native VHD from 208 centres in 28 European and North African countries who were followed for 6 months in 2017. Disease characteristics were assessed by sex. In addition, the researchers analysed whether the treatment received was concordant with Class I recommendations from VHD guidelines at that time (2012 ESC/European Association for Cardio-Thoracic Surgery guidelines and 2014 American Heart Association/American College of Cardiology guidelines).
Included patients had aortic stenosis (41.2%), aortic regurgitation (5.3%), mitral stenosis (4.5%), mitral regurgitation (21.3%), isolated right-sided VHD (2.7%) and multiple left-sided VHD (24.9%). Overall, women in the survey were older, more symptomatic and presented with a higher European System for Cardiac Operative Risk Evaluation (EuroSCORE) II score than men. Bicuspid aortic valve and aortic regurgitation were more prevalent among men, while mitral disease, concomitant tricuspid regurgitation and aortic stenosis in those over 65 years of age were more prevalent among women.
Regarding treatment in concordance with Class I indications of the guidelines at the time, the overall rate of interventions scheduled or performed was significantly lower in females than males (odds ratio [OR] 0.72; 95% CI 0.58 to 0.90; p=0.004). In particular, the analysis showed a significantly lower rate of interventional treatment after adjustment for the EuroSCORE II in women with mitral stenosis (OR 0.38; 95% CI 0.15 to 1.00; p=0.049) and primary mitral regurgitation (OR 0.60; 95% CI 0.38 to 0.96; p=0.034). Age, patient refusal and decline of symptoms after conservative treatment were reported significantly more often as reasons to withhold the intervention in females. Among all patients undergoing intervention for left-sided VHD, concomitant tricuspid intervention was performed at a similar frequency in both sexes (14.3% vs. 11.9% for women vs. men), although presence of moderate or severe tricuspid regurgitation was significantly more common in women. In-hospital and 6-month survival did not differ between the sexes.
Prof. Mascherbauer concludes, “The fact that sex differences exist in the treatment of VHD, particularly in mitral valve interventions, highlights the need for further research in order to provide optimal VHD treatment regardless of sex.”
References
- Iung B, et al. Circulation. 2019;140:1156–1169.
