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Multicenter Study
. 2021 Jan;8(1):e001443.
doi: 10.1136/openhrt-2020-001443.

IMPULSE: the impact of gender on the presentation and management of aortic stenosis across Europe

Richard Paul Steeds  1 , David Messika-Zeitoun  2 , Jeetendra Thambyrajah  3 , Antonio Serra  4 , Eberhard Schulz  5 , Jiri Maly  6   7 , Marco Aiello  8 , Tanja K Rudolph  9 , Guy Lloyd  10 , Alessandro Santo Bortone  11 , Alberto Clerici  12 , Georg Delle-Karth  13 , Johannes Rieber  14 , Ciro Indolfi  15 , Massimo Mancone  16 , Loic Belle  17 , Alexander Lauten  18 , Martin Arnold  19 , Berto J Bouma  20 , Matthias Lutz  21 , Cornelia Deutsch  22 , Jana Kurucova  23 , Martin Thoenes  24 , Peter Bramlage  25 , Norbert Frey  21 ; IMPULSE registry group
Affiliations
Multicenter Study

IMPULSE: the impact of gender on the presentation and management of aortic stenosis across Europe

Richard Paul Steeds et al. Open Heart. 2021 Jan.

Abstract

Aims: There is an increasing awareness of gender-related differences in patients with severe aortic stenosis and their outcomes after surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI).

Methods: Data from the IMPULSE registry were analysed. Patients with severe aortic stenosis (AS) were enrolled between March 2015 and April 2017 and stratified by gender. A subgroup analysis was performed to assess the impact of age.

Results: Overall, 2171 patients were enrolled, and 48.0% were female. Women were characterised by a higher rate of renal impairment (31.7 vs 23.3%; p<0.001), were at higher surgical risk (EuroSCORE II: 4.5 vs 3.6%; p=0.001) and more often in a critical preoperative state (7.0vs 4.2%; p=0.003). Men had an increased rate of previous cardiac surgery (9.4 vs 4.7%; p<0.001) and a reduced left ventricular ejection fraction (4.9 vs 1.3%; p<0.001). Concomitant mitral and tricuspid valve disease was substantially more common among women. Symptoms were highly prevalent in both women and men (83.6 vs 77.3%; p<0.001). AVR was planned in 1379 cases. Women were more frequently scheduled to undergo TAVI (49.3 vs 41.0%; p<0.001) and less frequently for SAVR (20.3 vs 27.5%; p<0.001).

Conclusions: The present data show that female patients with severe AS have a distinct patient profile and are managed in a different way to males. Gender-based differences in the management of patients with severe AS need to be taken into account more systematically to improve outcomes, especially for women.

Keywords: aortic valve stenosis; endovascular procedures; transcatheter aortic valve replacement.

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Conflict of interest statement

Competing interests: PB is the representative of the IPPMed, Cloppenburg, Germany. NF, RPS and DM-Z have received honoraria for advisory board meetings and TKR speakers’ honoraria from Edwards Lifesciences. The institutions of these three and those of the remaining authors representing study centres have received funding for employing a study nurse. JK and MT are employees of the funder of this registry. As this is a disease registry, neither the type of intervention (SAVR, TAVI or medical management) nor on the valves to be used was pre-specified.

Figures

Figure 1
Figure 1
Patient flow. AVR, aortic valve replacement; SAVR, surgical aortic valve replacement; TAVI, transcatheter aortic valve implantation.
Figure 2
Figure 2
Cardiac symptoms at baseline in (A) all patients and (B) those aged >80 years. **p<0.01, ***p<0.001. NYHA class III or IV: female 441/1024 (43.1) vs male 418/1118 (37.4); p=0.007. Angina class III or IV: female 43/909 (4.7) vs male 48/992 (4.8); p=0.912.
Figure 3
Figure 3
Treatment decision in (A) all patients and (B) those aged >80 years. AVR, aortic valve replacement; M, months; SAVR, surgical aortic valve implantation; TAVI, transcatheter aortic valve implantation. *p< 0.05, ***p<0.001. †Balloon aortic valvuloplasty, medical management or watchful waiting planned. Values are proportional to the number of patients with known treatment decisions.
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