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. 2024 Sep 6;3(10):101267.
doi: 10.1016/j.jacadv.2024.101267. eCollection 2024 Oct.

Sex-Specific Functional Status Decline and Outcomes in Mild-to-Moderate Aortic Stenosis: Results From the PROGRESSA Study

Lionel Tastet  1   2 , Mylène Shen  1 , Romain Capoulade  3 , Marie Arsenault  1 , Élisabeth Bédard  1 , Kathia Abdoun  1 , Marie-Ange Fleury  1 , Nancy Côté  1 , Philippe Pibarot  1 , Marie-Annick Clavel  1
Affiliations

Sex-Specific Functional Status Decline and Outcomes in Mild-to-Moderate Aortic Stenosis: Results From the PROGRESSA Study

Lionel Tastet et al. JACC Adv. .

Abstract

Background: Little is known about the effect of sex on functional status decline in aortic valve stenosis (AS) patients.

Objectives: The purpose of this study was to examine the changes in functional status according to sex in patients with mild-to-moderate AS and its association with the composite of death or aortic valve replacement (AVR).

Methods: We included patients with mild-to-moderate AS prospectively recruited in the PROGRESSA (Metabolic Determinants of the Progression of Aortic Stenosis) study (NCT01679431). Functional status was assessed using the New York Heart Association classification and the Duke Activity Status Index (DASI).

Results: A total of 244 patients (mean age 64 ± 14 years, 29% women) were included. The mean follow-up was 4.3 ± 2.4 years. Women with intermediate-to-fast AS progression rate (median change in peak aortic jet velocity ≥0.11 m/s/year) had significantly faster decline in DASI score compared to men with similar progression rate (P < 0.05). In linear mixed analysis adjusted for several clinical and echocardiographic factors, female sex and change in peak aortic jet velocity remained strongly associated with the worsening of New York Heart Association class and the decline of DASI score (all, P < 0.001). The composite of death or AVR occurred in 115 patients (16 deaths and 99 AVRs). In multivariable Cox regression analyses, functional status decline during follow-up remained significantly associated with the composite of death or AVR (HR: 2.13; 95% CI: 1.22-3.73; P = 0.008).

Conclusions: In patients with mild-to-moderate AS at baseline, intermediate-to-fast progression rate of AS was associated with a more rapid decline of functional status during follow-up, particularly in women. Functional status decline during follow-up was strongly associated with the incidence of death or AVR, with comparable effect in both women and men.

Keywords: aortic valve stenosis; functional status; sex differences.

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Conflict of interest statement

This work was supported by grants # FDN-143225 and MOP-114997 from the 10.13039/501100000024Canadian Institutes of Health Research (CIHR), Ottawa, Ontario, Canada, and a grant from the Foundation of the Québec Heart and Lung Institute. Dr Clavel holds the Canada Research Chair on Women’s Valvular Heart Health and Dr Pibarot the Canada Research Chair in Valvular Heart Diseases from CIHR, Ottawa, Ontario, Canada. Dr Capoulade holds a “Connect Talent” research chair from Region Pays de la Loire and Nantes Metropole (France). Dr Clavel has received funding from 10.13039/100006520Edwards Lifesciences for CT core laboratory analyses and research grant from 10.13039/100004374Medtronic in the field of surgical aortic valve bioprosthesis with no direct personal compensation. Dr Pibarot has received funding from 10.13039/100006520Edwards Lifesciences and 10.13039/100004374Medtronic for echocardiography core laboratory analyses in the field of transcatheter and surgical aortic valve replacement with no direct personal compensation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
NYHA Functional Class According to Sex and AS Progression Rate Comparison of NYHA functional class at baseline, 2-year, and 5-year follow-up between women and men, and according to hemodynamic progression rate of AS. Intermediate-to-fast versus slow progression rate of AS was defined as annualized change in Vpeak ≥11 or <0.11 m/s/year. ♀ = Women; ♂ = Men. AS = aortic valve stenosis; Vpeak = peak aortic jet velocity.
Figure 2
Figure 2
Change in DASI Score According to Sex and AS Progression Rate Linear prediction of the change in DASI score from baseline to 5-year follow-up between women and men (A), and according to sex and AS progression rate (B). ∗Indicates significant between-group difference (ie P < 0.05). P values were obtained after linear mixed analyses. ΔIndicates the change from baseline visit. DASI = Duke Activity Status Index; other abbreviation as in Figure 1.
Figure 3
Figure 3
Incidence of the Composite of Death or AVR According to Functional Status Decline Kaplan-Meier curves of the cumulative incidence of death from any cause or AVR according to functional status decline (A), and functional status decline and sex (B). Functional status decline was defined as an increase in NYHA functional class (≥1 class) and/or a faster decline in DASI score (annualized score decline <-2 points/year, ie, median of the entire cohort) during follow-up. AVR = aortic valve replacement; FS = functional status; other abbreviations as in Figures 1 and 2.
Central Illustration
Central Illustration
Sex-Related Differences in the Decline of Functional Status in Patients With Mild-to-Moderate AS Among patients with mild-to-moderate AS at baseline, women present with more symptoms and have worse decline in health status for similar AS hemodynamic progression rate. Abbreviations as in Figure 1, Figure 2, Figure 3.
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