Impact of Left Ventricular Mass on Mortality in Symptomatic Severe Aortic Stenosis: A Sex-Specific Analysis

Aortic stenosis (AS) is a prevalent valvular heart disease, especially among older adults, and is associated with high morbidity and mortality. Left ventricular mass (LVM) in-creases in response to pressure overload in AS. However, excessive LVM is associated with adverse outcomes. The prognostic implications of LVM, particularly potential sex-specific effects on mortality, remain unclear. We conducted a retrospective sin-gle-center cohort study of 531 outpatients with symptomatic but stable severe AS awaiting valve intervention between April 2020 and February 2024. None had prior valve procedures. Baseline clinical and echocardiographic data were collected, and pa-tients were followed for a mean of 2.67 years. The cohort included 283 men and 248 women (mean age 74.7 years). During follow-up, 165 patients (31.1%) died, with 86% of deaths due to cardiovascular causes. Deceased patients had lower left ventricular ejec-tion fraction (LVEF) and higher LVM index (LVMi) than survivors. Multivariate analysis showed that LVMi and atrial fibrillation (AF) were independent predictors of mortality. In women, LVMi, LVEF, and AF were independently associated with death, while no such predictors were identified in men. In conclusion, elevated LVMi was inde-pendently associated with increased mortality in patients with severe AS, particularly among women.