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Heart Valve Disease in Women

  • Eva GerdtsEmail author
Chapter

Abstract

Sex-differences are present in the various types of aortic valve disease and aortic root abnormalities. The typical aortic stenosis (AS) patient with a small aortic root is an elderly woman with atherosclerosis and reduced systemic arterial compliance. Sex-differences in outcomes after transcatheter aortic valve replacement (TAVR) are still debated. Primary mitral regurgitation (MR) is more common among women, while secondary MR is more common among men. Women with severe MR are diagnosed and operated at a later stage than men. This chapter gives an update on current diagnosis and management of women with AS or MR, the most common types of valvular heart disease.

Keywords

Aortic root diameter Aortic stenosis (AS) Aortic valve disease Echocardiography LV adaptation Mitral regurgitation (MR) Surgical aortic valve replacement (SAVR) Transcatheter aortic valve replacement (TAVR) Transvalvular flow Valvular heart disease 

References

  1. 1.
    Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin 3rd JP, Guyton RA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt 3rd TM, Thomas JD. American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63:2438–88.CrossRefPubMedGoogle Scholar
  2. 2.
    Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC); European Association for Cardio-Thoracic Surgery (EACTS), Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G, Baumgartner H, Borger MA, Carrel TP, De Bonis M, Evangelista A, Falk V, Iung B, Lancellotti P, Pierard L, Price S, Schäfers HJ, Schuler G, Stepinska J, Swedberg K, Takkenberg J, Von Oppell UO, Windecker S, Zamorano JL, Zembala M. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J. 2012;33:2451–96.CrossRefGoogle Scholar
  3. 3.
    Eveborn GW, Schirmer H, Heggelund G, Lunde P, Rasmussen K. The evolving epidemiology of valvular aortic stenosis. the Tromsø study. Heart. 2013;99:396–400.CrossRefPubMedGoogle Scholar
  4. 4.
    Stewart BF, Siscovick D, Lind BK, Gardin JM, Gottdiener JS, Smith VE, Kitzman DW, Otto CM. Clinical factors associated with calcific aortic valve disease. Cardiovascular Health Study. J Am Coll Cardiol. 1997;29:630–4.CrossRefPubMedGoogle Scholar
  5. 5.
    Siu SC, Silversides CK. Bicuspid aortic valve disease. J Am Coll Cardiol. 2010;55:2789–800.CrossRefPubMedGoogle Scholar
  6. 6.
    Davies MJ, Treasure T, Parker DJ. Demographic characteristics of patients undergoing aortic valve replacement for stenosis: relation to valve morphology. Heart. 1996;75(2):174–8.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Rieck ÅE, Cramariuc D, Boman K, Gohlke-Bärwolf C, Staal EM, Lønnebakken MT, Rossebø AB, Gerdts E. Hypertension in aortic stenosis: implications for left ventricular structure and cardiovascular events. Hypertension. 2012;60:90–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Rogge BP, Cramariuc D, Lønnebakken MT, Gohlke-Bärwolf C, Chambers JB, Boman K, Gerdts E. Effect of overweight and obesity on cardiovascular events in asymptomatic aortic stenosis: a SEAS Substudy (Simvastatin ezetimibe in aortic stenosis). J Am Coll Cardiol. 2013;62:1683–90.CrossRefPubMedGoogle Scholar
  9. 9.
    Gerdts E, Rossebø AB, Pedersen TR, Cioffi G, Lønnebakken MT, Cramariuc D, Rogge BP, Devereux RB. Relation of left ventricular mass to prognosis in initially asymptomatic mild to moderate aortic valve stenosis. Circ Cardiovasc Imaging. 2015;8:e003644.PubMedPubMedCentralGoogle Scholar
  10. 10.
    Rogge BP, Gerdts E, Cramariuc D, Bahlmann E, Jander N, Gohlke-Bärwolf C, Pedersen TR, Lønnebakken MT. Impact of obesity and nonobesity on grading the severity of aortic valve stenosis. Am J Cardiol. 2014;113:1532–5.CrossRefPubMedGoogle Scholar
  11. 11.
    Bahlmann E, Cramariuc D, Gerdts E, Gohlke-Baerwolf C, Nienaber CA, Eriksen E, Wachtell K, Chambers J, Kuck KH, Ray S. Impact of pressure recovery on echocardiographic assessment of asymptomatic aortic stenosis: a SEAS substudy. JACC Cardiovasc Imaging. 2010;3:555–62.CrossRefPubMedGoogle Scholar
  12. 12.
    Bahlmann E, Cramariuc D, Minners J, Lønnebakken MT, Ray S, Gohlke-Baerwolf C, Nienaber CA, Jander N, Seifert R, Chambers JB, Kuck KH, Gerdts E. Small aortic root in aortic valve stenosis: clinical characteristics and prognostic implications. Eur Heart J Cardiovasc Imaging. 2017;18(4):404–12.Google Scholar
  13. 13.
    Muraru D, Maffessanti F, Kocabay G, Peluso D, Dal Bianco L, Piasentini E, Jose SP, Iliceto S, Badano LP. Ascending aorta diameters measured by echocardiography using both leading edge-to-leading edge and inner edge-to-inner edge conventions in healthy volunteers. Eur Heart J Cardiovasc Imaging. 2014;15:415–22.CrossRefPubMedGoogle Scholar
  14. 14.
    Bahlmann E, Gerdts E, Cramariuc D, Gohlke-Baerwolf C, Nienaber CA, Wachtell K, Seifert R, Chambers JB, Kuck KH, Ray S. Prognostic value of energy loss index in asymptomatic aortic stenosis. Circulation. 2013;127:1149–56.CrossRefPubMedGoogle Scholar
  15. 15.
    Cramariuc D, Rogge BP, Lønnebakken MT, Boman K, Bahlmann E, Gohlke-Bärwolf C, Chambers JB, Pedersen TR, Gerdts E. Sex differences in cardiovascular outcome during progression of aortic valve stenosis. Heart. 2015;101:209–14.CrossRefPubMedGoogle Scholar
  16. 16.
    Douglas PS, Otto CM, Mickel MC, Labovitz A, Reid CL, Davis KB. Gender differences in left ventricle geometry and function in patients undergoing balloon dilatation of the aortic valve for isolated aortic stenosis. NHLBI Balloon Valvuloplasty Registry. Br Heart J. 1995;73:548–54.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Cramariuc D, Rieck AE, Staal EM, Wachtell K, Eriksen E, Rossebø AB, Gerdts E. Factors influencing left ventricular structure and stress-corrected systolic function in men and women with asymptomatic aortic valve stenosis (a SEAS substudy). Am J Cardiol. 2008;101:510–5.CrossRefPubMedGoogle Scholar
  18. 18.
    Carroll JD, Carroll EP, Feldman T, Ward DM, Lang RM, McGaughey D, Karp RB. Sex-associated differences in left ventricular function in aortic stenosis of the elderly. Circulation. 1992;86:1099–107.CrossRefPubMedGoogle Scholar
  19. 19.
    Villari B, Campbell SE, Schneider J, Vassalli G, Chiariello M, Hess OM. Sex-dependent differences in left ventricular function and structure in chronic pressure overload. Eur Heart J. 1995;16:1410–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Petrov G, Regitz-Zagrosek V, Lehmkuhl E, Krabatsch T, Dunkel A, Dandel M, Dworatzek E, Mahmoodzadeh S, Schubert C, Becher E, Hampl H, Hetzer R. Regression of myocardial hypertrophy after aortic valve replacement: faster in women? Circulation. 2010;122(11 Suppl):S23–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Queirós AM, Eschen C, Fliegner D, Kararigas G, Dworatzek E, Westphal C, Sanchez Ruderisch H, Regitz-Zagrosek V. Sex- and estrogen-dependent regulation of a miRNA network in the healthy and hypertrophied heart. Int J Cardiol. 2013;169:331–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Capoulade R, Le Ven F, Clavel MA, Dumesnil JG, Dahou A, Thébault C, Arsenault M, O'Connor K, Bédard É, Beaudoin J, Sénéchal M, Bernier M, Pibarot P. Echocardiographic predictors of outcomes in adults with aortic stenosis. Heart. 2016;102:934–42.CrossRefPubMedGoogle Scholar
  23. 23.
    Aggarwal SR, Clavel MA, Messika-Zeitoun D, Cueff C, Malouf J, Araoz PA, Mankad R, Michelena H, Vahanian A, Enriquez-Sarano M. Sex differences in aortic valve calcification measured by multidetector computed tomography in aortic stenosis. Circ Cardiovasc Imaging. 2013;6:40–7.CrossRefPubMedGoogle Scholar
  24. 24.
    Clavel MA, Pibarot P, Messika-Zeitoun D, Capoulade R, Malouf J, Aggarval S, Araoz PA, Michelena HI, Cueff C, Larose E, Miller JD, Vahanian A, Enriquez-Sarano M. Impact of aortic valve calcification, as measured by MDCT, on survival in patients with aortic stenosis: results of an international registry study. J Am Coll Cardiol. 2014;64:1202–13.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR, Williams M, Dewey T, Kapadia S, Babaliaros V, Thourani VH, Corso P, Pichard AD, Bavaria JE, Herrmann HC, Akin JJ, Anderson WN, Wang D, Pocock SJ. PARTNER Trial Investigators. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364:2187–98.CrossRefPubMedGoogle Scholar
  26. 26.
    Williams M, Kodali SK, Hahn RT, Humphries KH, Nkomo VT, Cohen DJ, Douglas PS, Mack M, McAndrew TC, Svensson L, Thourani VH, Tuzcu EM, Weissman NJ, Kirtane AJ, Leon MB. Sex-related differences in outcomes after transcatheter or surgical aortic valve replacement in patients with severe aortic stenosis: insights from the PARTNER Trial (Placement of Aortic Transcatheter Valve). J Am Coll Cardiol. 2014;63:1522–8.CrossRefPubMedGoogle Scholar
  27. 27.
    Petrov G, Dworatzek E, Schulze TM, Dandel M, Kararigas G, Mahmoodzadeh S, Knosalla C, Hetzer R, Regitz-Zagrosek V. Maladaptive remodeling is associated with impaired survival in women but not in men after aortic valve replacement. JACC Cardiovasc Imaging. 2014;7:1073–80.CrossRefPubMedGoogle Scholar
  28. 28.
    Devereux RB, Kramer-Fox R, Kligfield P. Mitral valve prolapse: causes, clinical manifestations, and management. Ann Intern Med. 1989;111:305–17.CrossRefPubMedGoogle Scholar
  29. 29.
    Avierinos JF, Inamo J, Grigioni F, Gersh B, Shub C, Enriquez-Sarano M. Sex differences in morphology and outcomes of mitral valve prolapse. Ann Intern Med. 2008;149:787–95.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Devereux RB, Jones EC, Roman MJ, Howard BV, Fabsitz RR, Liu JE, Palmieri V, Welty TK, Lee ET. Prevalence and correlates of mitral valve prolapse in a population-based sample of American Indians: the Strong Heart Study. Am J Med. 2001;111:679–85.CrossRefPubMedGoogle Scholar
  31. 31.
    Jones EC, Devereux RB, Roman MJ, Liu JE, Fishman D, Lee ET, Welty TK, Fabsitz RR, Howard BV. Prevalence and correlates of mitral regurgitation in a population-based sample (the Strong Heart Study). Am J Cardiol. 2001;87:298–304.CrossRefPubMedGoogle Scholar
  32. 32.
    Stone GW, Vahanian AS, Adams DH, Abraham WT, Borer JS, Bax JJ, Schofer J, Cutlip DE, Krucoff MW, Blackstone EH, Généreux P, Mack MJ, Siegel RJ, Grayburn PA, Enriquez-Sarano M, Lancellotti P, Filippatos G, Kappetein AP, Mitral Valve Academic Research Consortium (MVARC). Clinical trial design principles and endpoint definitions for transcatheter mitral valve repair and replacement: part 1: clinical trial design principles: a consensus document from the Mitral Valve Academic Research Consortium. J Am Coll Cardiol. 2015;66:278–307.CrossRefPubMedGoogle Scholar
  33. 33.
    Enriquez-Sarano M, Akins CW, Vahanian A. Mitral regurgitation. Lancet. 2009;373:1382–94.CrossRefPubMedGoogle Scholar
  34. 34.
    Vassileva CM, McNeely C, Mishkel G, Boley T, Markwell S, Hazelrigg S. Gender differences in long-term survival of Medicare beneficiaries undergoing mitral valve operations. Ann Thorac Surg. 2013;96:1367–73.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of Clinical ScienceUniversity of BergenBergenNorway

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