Women are more likely to have severe aortic stenosis missed on echocardiography results
Women are less likely than men to receive a clinical diagnosis of AS following a diagnostic transthoracic echocardiogram (TTE), according to new findings published in JACC: Advances.[1] This difference persists even though AS is just as prevalent in men as it is in women.
“The historical absence of standardized echocardiography reporting for AS and quality metrics evaluating the entire continuum of care from echocardiographic diagnosis to treatment of significant AS has limited our understanding of contributors to sex disparities in AS care,” wrote first author Daniela Crousillat, MD, an interventional cardiologist with USF Health, and colleagues. “Limited data exist on sex differences in the recognition of clinically significant AS following a diagnostic TTE, a critical first step in the initiation of AS care.”
Crousillat et al. explored data from more than 2,000 patients who underwent a TTE at one of two large academic centers from 2015 to 2020. All patients showed signs of at least moderate AS. Approximately 51% of patients were men. While 82.7% patients underwent a TTE in an outpatient setting, 75.4% of TTEs were ordered by a clinicians who were not cardiologists.
Overall, 52.4% of patients with at least moderate AS received a diagnosis of AS within one year of undergoing their index TTE. A clinical diagnosis of AS occurred in 55.7% of men and 48.9% of women. Among patients with severe AS, 74.3% of men and 64.1% of women received an official diagnosis. Among patients with moderate AS, meanwhile, 44.9% of men and 40.4% of women received an official diagnosis. The authors did not find that difference to be statistically significant.
Another key takeaway from this analysis was the fact that diagnosis rates were comparable between men and women with severe high-gradient AS—defined as a transvalvular mean pressure gradient (MG) >40 mm Hg and an aortic valve area (AVA) <1 cm2—but women were much less likely to be diagnosed if they presented with severe low-gradient AS, defined as an MG <40 mm Hg and AVA <1 cm2, than men.
“The appropriate recognition and diagnosis of significant AS by echocardiography represents a primordial and essential step in cascade of appropriate downstream treatment strategies,” the authors wrote. “No current echocardiography reporting standards exist regarding the inclusion of a summative assessment of AS severity or recommendations regarding a follow-up plan among patients identified to have severe AS. Our study findings reflect gaps in access to subspecialty care (only 25% of TTEs were ordered by cardiologists) and significant delays in the recognition of significant AS. We hypothesize these gaps may lead to delays in appropriate referral of significant AS as the majority of TTEs are ordered by noncardiology providers who may be less familiar with diagnostic echocardiographic parameters and treatment guidelines, particularly for cases with discordant findings which are more prevalent among women.”
Crousillat and colleagues also called for more research into “standardized echocardiography reporting standards, artificial intelligence-based diagnostic algorithms and automated EHR alert systems” to help address these differences between male and female heart patients.
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Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.