Article Impact Level: HIGH Data Quality: STRONG Summary of European Heart Journal, ehae523. https://doi.org/10.1093/eurheartj/ehae523 Dr. Julia Mascherbauer et al.
Points
- This study evaluated sex differences in characteristics and treatment of 5,219 patients with severe native valvular heart disease (VHD) from 208 centers across Europe and North Africa.
- Women were generally older, more symptomatic, and had higher EuroSCORE II values. At the same time, men were more likely to have bicuspid aortic valves and aortic regurgitation, and women had more cases of mitral disease, tricuspid regurgitation, and aortic stenosis.
- Women with mitral stenosis and primary mitral regurgitation were less likely to receive treatments aligned with guideline recommendations, often due to factors like advanced age, symptom resolution, and patient refusal.
- Despite differences in treatment approaches, survival rates at six months and in-hospital mortality were similar between men and women.
- The study emphasizes sex-based disparities in disease patterns and treatment concordance, though these differences did not affect short-term survival outcomes.
Summary
This study evaluated sex differences in the characteristics and treatment of patients with severe native valvular heart disease (VHD) based on data from the VHD II EURObservational Research Programme. The cohort included 5,219 patients from 208 centers across Europe and North Africa, with conditions such as 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%). The study aimed to assess whether treatment decisions aligned with the 2012 ESC or 2014 AHA/ACC guidelines, particularly concerning gender differences.
The analysis revealed significant differences in disease presentation between men and women. Women were generally older, more symptomatic, and had higher EuroSCORE II values. Men were more likely to have bicuspid aortic valves and aortic regurgitation, while women were more frequently diagnosed with mitral disease, tricuspid regurgitation, and aortic stenosis in patients over 65. Multivariable regression analysis showed that women with mitral stenosis and primary mitral regurgitation were less likely to receive treatment by guideline recommendations (P < .001). Factors like advanced age, symptom resolution after conservative management, and patient refusal were cited more frequently as reasons for withholding interventions in women.
Despite these differences in treatment, survival rates between men and women at six months were comparable. In-hospital mortality also did not differ significantly between sexes. The study highlights that while there are notable differences in disease patterns and treatment concordance based on sex, these disparities did not translate into differences in short-term survival outcomes.
Link to the article: https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehae523/7738051
References Mascherbauer, J., Kammerlander, A., Nitsche, C., Bax, J., Delgado, V., Evangelista, A., Laroche, C., Maggioni, A. P., Magne, J., Vahanian, A., Iung, B., EORP VHD II Registry Investigators Group, Zera, E., Shirka, E., Dado, E., Mascherbauer, J., Heger, M., Samadov, F., Rustamova, Y., … Karabag, T. (2024). Sex-related differences in severe native valvular heart disease: The ESC-EORP Valvular Heart Disease II survey. European Heart Journal, ehae523. https://doi.org/10.1093/eurheartj/ehae523
