Sex-Related Discordance Between Aortic Valve Calcification and Hemodynamic Severity of Aortic Stenosis

Rationale:Calcific aortic stenosis (AS) is characterized by calcium deposition in valve leaflets. However, women present lower aortic valve calcification loads than men for the same AS hemodynamic severity. Objective:We, thus, aimed to assess sex differences in aortic valve fibrocalcific remodeling. Methods and Results:One hundred and twenty-five patients underwent Doppler echocardiography and multidetector computed tomography within 3 months before aortic valve replacement. Explanted stenotic tricuspid aortic valves were weighed, and fibrosis degree was determined. Sixty-four men and 39 women were frequency matched for age, body mass index, hypertension, renal disease, diabetes mellitus, and AS severity. Mean age (75±9 years), mean gradient (41±18 mm Hg), and indexed aortic valve area (0.41±0.12 cm2/m2) were similar between men and women (all P≥0.18). Median aortic valve calcification (1973 [1124–3490] Agatston units) and mean valve weight (2.36±0.99 g) were lower in women compared with men (both P<0.000...