Gender specific differences in functional capacity in asymptomatic patients with severe aortic stenosis

Abstract

Female gender has been linked to increased risk of adverse events after surgical aortic valve replacement but with better outcome after TAVI. Less is known regarding functional capacity between the genders with severe AS. We investigated whether there is a gender difference in functional capacity in asymptomatic group of patients with severe AS. Method: Asymptomatic patients with severe AS were prospectively enrolled and underwent cardiopulmonary exercise testing (CPET) on supine ergobicycle, ramp protocol, 15 W/min. Patients with test positive for ischemia were excluded. Results: There were 139 patients, 61 women. There were no baseline gender differences in age (66.11 vs 64.8, p = ns), echo parameters of AS severity (Vmax 4.53 vs 4.53 m/s, and Pmean 52.27 vs 53.42 mmHg, all p = ns) except AVA (0.75 ± 0.1 vs 0.63 ± 0.17), LVEF (68.7 vs 71.6%), E/e’ (12.6 vs 14.3) and BNP (92.5 vs 103 pg/ml), all p = ns. Women had higher body mass index (29.5 vs 27.3, p = 0.018), lower VO2max (13.10 vs 17.6 ml/kg/m2, p = 0.001) and higher VE/VCO2 slope (33.69 vs 28.87, p = 0.004). Univariable/multivariable linear regression analyses were used to test the relation between clinical and echocardiographic characteristics with VO2max. The variables independently associated with the VO2max were female gender (beta = –0.365, p = 0.002), Vmax (beta= –0.341, p = 0.004), age (beta = –0.239, p = 0.035) and BMI (beta = –0.246, p = 0.028) Conclusion: Female gender is the strongest independent predictor of decreased functional capacity, even when adjusting for other variables, including BMI and echo markers of AS severity. Further studies are needed to determine whether this finding affects the outcome of the disease.