Increased mortality in women with severe aortic stenosis and low ejection fraction
Notice bibliographique
Résumé
Abstract Background Women with severe aortic stenosis (AS) tend to be operated with more advanced valvular heart disease. They also have worse survival after aortic valve replacement (AVR). This difference between sexes in surgical referral and its relationship to mortality have not been previously studied in patients with severe AS and low left ventricular ejection fraction (LVEF). Purpose To assess sex differences in patients with severe AS and low LVEF, and to evaluate their potential association with mortality. Methods This is a retrospective study of consecutive patients presenting with a diagnosis of severe AS and low LVEF (≤50%) on echocardiogram, at the Quebec Heart and Lung Institute between 2004–2015. Patients were excluded if they had congenial or rheumatic heart disease, and/or more than moderate aortic regurgitation. Patients were compared according to sex for incidence of AVR and long-term all-cause mortality with univariate (Kaplan-Meyer with log-rank test), and multivariate analysis (Cox regression model) adjusting for baseline comorbidities, LVEF and severity of valvular disease. Results Our database had a total of 1129 patients, of which 578 were included in the analysis. There were 149 women (26%). Mean follow-up time was 3.10±3.04 years (1795 patient-years). There were 279 AVR and 284 deaths. Women were older (77±11 vs 74±10 years, p=0.004), and had less coronary artery disease (60% vs 79%, p<0.001) and dyslipidemia (55% vs 72%, p<0.001). Women had comparable severity of AS at baseline, with better LVEF (37% vs 35%, p=0.02). In univariate analysis, there was a strong tendency for increased mortality in women compared to men (p=0.06). After comprehensive baseline adjustement, female sex was predictive of mortality (HR 1.33 [1.00–1.75], p=0.04). Women were also less likely to be operated than men (HR 0.70 [0.51–0.94], p=0.02). After further adjustment for AVR as a time-dependent variable, there was only a trend toward the significance of sex as a predictor of mortality (p=0.12). In a sex-specific analysis of predictors of mortality, LVEF was predictive of mortality in women (HR 0.97 [0.94–0.99], p=0.007), while not in men (0.99 [0.98–1.01], p=0.51). Conclusions Despite adjustment for comorbidities and AS severity, women were less likely to be referred to AVR and had a higher overall mortality. After adjustment for AVR, female sex was no longer a predictor of mortality, underlying the negative impact of the lack of treatment in women with decreased LVEF. Thus underrecognition and suboptimal management of severe AS in female patients with low LVEF should be further investigated to identify contributing factors and possible solutions. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Dr Clavel has received a grant from the Heart and Stroke Foundation of Canada
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».