Specificities of Aortic Stenosis in Women – From Diagnosis to Management

Authors

• Yasser Harb, Cardiology Department, Clemenceau Medical Center, University of Balamand, Beirut, Lebanon
• Fadi Tohme, Cardiology Department, Clemenceau Medical Center, University of Balamand, Beirut, Lebanon
• Hadi Ossaili, Cardiology Department, Clemenceau Medical Center, University of Balamand, Beirut, Lebanon
• Karim Halabi, Cardiology Department, Clemenceau Medical Center, University of Balamand, Beirut, Lebanon
• Ali Kanso, Cardiology Department, LAU Medical Center Rizk Hospital, Lebanese American University, Beirut, Lebanon
• Elie Chammas, Cardiology Department, Clemenceau Medical Center, University of Balamand, Beirut, Lebanon
• Samer Nasr, Cardiology Department, Mont Liban Hospital, University of Balamand, Beirut, Lebanon
• Mohammad Tahini, Cardiology Department, Clemenceau Medical Center, University of Balamand, Beirut, LebanonFollow
• Nicole Karam, Cardiology Department, Clemenceau Medical Center, University of Balamand, Beirut, Lebanon

Abstract

Aortic stenosis (AS) is the most common valvular heart disease worldwide, with pathophysiology, clinical presentation, and management differing widely according to sex. Women demonstrate predominantly fibrotic valve modifications and less calcifications for given hemodynamic severity, with left ventricular concentric hypertrophy and smaller cavity size leading to a higher prevalence of paradoxical low-flow, low-gradient AS. These sex differences are modulated by hormonal changes, inflammatory and metabolic pathways, as well as genetic and epigenetic regulators. Atypical symptoms and hemodynamic specificities on echocardiography all combine to create diagnostic challenges that contribute to delayed recognition and intervention. Multimodality imaging, particularly the use of sex-specific calcium scoring cutoffs and CMR-derived fibrosis markers, enhances diagnostic precision. While special considerations such as small valvular annulus and peripheral arteries, have to be taken into consideration, both approaches are safe and beneficial in women. The current manuscript reviews sex specificities of AS, in terms of pathophysiology, diagnosis and management.

Article Type

Special Issue: Review Article

First Page

552

Last Page

560

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

Recommended Citation

Harb, Yasser; Tohme, Fadi; Ossaili, Hadi; Halabi, Karim; Kanso, Ali; Chammas, Elie; Nasr, Samer; Tahini, Mohammad; and Karam, Nicole (2026) "Specificities of Aortic Stenosis in Women – From Diagnosis to Management," Saudi Medical Journal: Vol. 47: Iss. 3, Article 18.
DOI: https://doi.org/10.15537/1658-3175.1052