title: Sex differences in aortic valve calcification measured by multidetector computed tomography in aortic stenosis.
abstract: BACKGROUND
  Aortic valve calcification (AVC) is the intrinsic mechanism of valvular obstruction leading to aortic stenosis (AS) and is measurable by multidetector computed tomography. The link between sex and AS is controversial and that with AVC is unknown.
  
  
  RESULTS
  We prospectively performed multidetector computed tomography in 665 patients with AS (aortic valve area, 1.05±0.35 cm(2); mean gradient, 39±19 mm Hg) to measure AVC and to assess the impact of sex on the AVC-AS severity link in men and women. AS severity was comparable between women and men (peak aortic jet velocity: 4.05±0.99 versus 3.93±0.91 m/s, P=0.11; aortic valve area index: 0.55±0.20 versus 0.56±0.18 cm(2)/m(2); P=0.46). Conversely, AVC load was lower in women versus men (1703±1321 versus 2694±1628 arbitrary units; P<0.0001) even after adjustment for their smaller body surface area or aortic annular area (both P<0.0001). Thus, odds of high-AVC load were much greater in men than in women (odds ratio, 5.07; P<0.0001). Although AVC showed good associations with hemodynamic AS severity in men and women (all r>0.67; P<0.0001), for any level of AS severity measured by peak aortic jet velocity or aortic valve area index, AVC load, absolute or indexed, was higher in men versus women (all P≤0.01).
  
  
  CONCLUSIONS
  In this large AS population, women incurred similar AS severity than men for lower AVC loads, even after indexing for their smaller body size. Hence, the relationship between valvular calcification process and AS severity differs in women and men, warranting further pathophysiological inquiry. For AS severity diagnostic purposes, interpretation of AVC load should be different in men and in women.
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Shivani R
authors.initials: SR
authors.lastname: Aggarwal
authors.forename: Marie-Annick
authors.initials: MA
authors.lastname: Clavel
authors.forename: David
authors.initials: D
authors.lastname: Messika-Zeitoun
authors.forename: Caroline
authors.initials: C
authors.lastname: Cueff
authors.forename: Joseph
authors.initials: J
authors.lastname: Malouf
authors.forename: Philip A
authors.initials: PA
authors.lastname: Araoz
authors.forename: Rekha
authors.initials: R
authors.lastname: Mankad
authors.forename: Hector
authors.initials: H
authors.lastname: Michelena
authors.forename: Alec
authors.initials: A
authors.lastname: Vahanian
authors.forename: Maurice
authors.initials: M
authors.lastname: Enriquez-Sarano
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D002114:Calcinosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D061330:Multidetector Computed Tomography / Q000379:methods*; D011446:Prospective Studies; D012720:Severity of Illness Index; D017678:Sex Distribution; D012737:Sex Factors; D014481:United States / Q000453:epidemiology