IMPULSE: The impact of gender on the presentation and management of aortic stenosis across Europe

Richard Paul Steeds, David Messika-Zeitoun, Jeetendra Thambyrajah, Antonio Serra, Eberhard Schulz, Jiri Maly, Marco Aiello, Tanja K. Rudolph, Guy Lloyd, Alessandro Santo Bortone, Alberto Clerici, Georg Delle-Karth, Johannes Rieber, Ciro Indolfi, Massimo Mancone, Loic Belle, Alexander Lauten, Martin Arnold, Berto J. Bouma, Matthias LutzCornelia Deutsch, Jana Kurucova, Martin Thoenes, Peter Bramlage, Norbert Frey

Research output: Contribution to journalArticlepeer-review


Aims There is an increasing awareness of gender-related differences in patients with severe aortic stenosis and their outcomes after surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI). Methods Data from the IMPULSE registry were analysed. Patients with severe aortic stenosis (AS) were enrolled between March 2015 and April 2017 and stratified by gender. A subgroup analysis was performed to assess the impact of age. Results Overall, 2171 patients were enrolled, and 48.0% were female. Women were characterised by a higher rate of renal impairment (31.7 vs 23.3%; p<0.001), were at higher surgical risk (EuroSCORE II: 4.5 vs 3.6%; p=0.001) and more often in a critical preoperative state (7.0vs 4.2%; p=0.003). Men had an increased rate of previous cardiac surgery (9.4 vs 4.7%; p<0.001) and a reduced left ventricular ejection fraction (4.9 vs 1.3%; p<0.001). Concomitant mitral and tricuspid valve disease was substantially more common among women. Symptoms were highly prevalent in both women and men (83.6 vs 77.3%; p<0.001). AVR was planned in 1379 cases. Women were more frequently scheduled to undergo TAVI (49.3 vs 41.0%; p<0.001) and less frequently for SAVR (20.3 vs 27.5%; p<0.001). Conclusions The present data show that female patients with severe AS have a distinct patient profile and are managed in a different way to males. Gender-based differences in the management of patients with severe AS need to be taken into account more systematically to improve outcomes, especially for women.

Original languageEnglish
Article numbere001443
JournalOpen Heart
Issue number1
Publication statusPublished - Jan 8 2021


  • aortic valve stenosis
  • endovascular procedures
  • transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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