Sex Differences in Bicuspid Aortic Valve Adults
Who Deserves Our Attention, Men or Women?
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
The cock may crow, but it’s the hen who lays the egg.
—Proverb quoted by Margaret Thatcher
The clinical holy grail of the bicuspid aortic valve (BAV) condition has centered on reconciling its heterogeneous valvulo-aortopathy phenotypes with its associated clinical outcomes, which are also exceedingly heterogenous.1 With that intent, and based on the premise that “gender differences in BAV patients have not been extensively studied,” Kong et al2 in this issue of Circulation: Cardiovascular Imaging present an important multicenter cross-sectional analysis of associations between BAV valvulo-aortopathy phenotypes and sex within a large 1992-patient tertiary cohort. The authors must be congratulated for this multicenter international effort and for defining the baseline morphological valvular and aortopathy phenotypes for each patient within such a large cohort. The authors then report sex-specific phenotypic and morbidity associations. However, their study seems to fall short at the result interpretation level in relation to the context of prior existing research. In addition, the potential clinical implications of their findings may not be as simple as discussed. We recently reported a comprehensive, single-center, long-term clinical follow-up assessment of sex differences and survival in BAV adults where sex-specific morbidity and mortality patterns were verified in 3 different contemporary BAV adult cohorts3: A 416-patient community cohort, a 2824-patient tertiary-referral cohort, and a 2242-patient aortic valve replacement (AVR)-referral cohort (Table). Of these cohorts, the tertiary one is of particular interest because it compares methodologically to the cohort presented by Kong et al.2
See Article by Kong et al
Sex-Specific BAV-Related Phenotypes and Morbidity
Available data suggest that there are no significant associations between BAV phenotypes and sex, at least within large contemporary studies in adults,2–4 a notion that could differ in children. In their …