BACKGROUND: Management and treatment of severe aortic stenosis (AS) may differ considerably in European countries. To investigate these differences in France, Germany, and the UK, the IMPULSE enhanced registry was established. Previous data revealed differences in how patients were managed in specialist (hub) versus primary/secondary care (satellite) centres. METHODS: The IMPULSE enhanced registry sub-analysis aimed to determine if there were gender-specific differences for patients with severe AS at centres with and without access to intervention. RESULTS: Among the 790 patients, 594 and 196 were recruited at hub and satellite centres, respectively; 44 % of patients were female. In both settings, women were older than men (hubs: 78.7 vs. 76.2, p = 0.007; satellites: 79.8 vs. 75.1, p = 0.002). Symptoms at the presentation were comparable. Males had more often undergone previous cardiac surgery. Females had a smaller left ventricular (LV) outflow tract, smaller LV cavities, and, more often, a preserved ejection fraction (>50 %). There was no gender-based difference in time to intervention. At one year, the cumulative incidence of aortic valve replacement in females was higher than in males in hubs (p = 0.012) but not in satellites (p = 0.600); surgical AVR was more common in males in hubs only (p = 0.008), while transcatheter aortic valve implantation was more common in females in both settings (hubs: p < 0.001; satellites: p = 0.022). One-year survival was comparable in both genders, regardless of setting. CONCLUSIONS: A better understanding of gender-specific differences in patients with severe AS, according to the diagnostic setting, could improve patient stratification and earlier diagnosis.

Department of Cardiology Angiology and Pneumology Heidelberg University Hospital Heidelberg Germany

Department of Cardiology Inselspital Bern University Hospital University of Bern Freiburgstrasse 18 3010 Bern Switzerland

Department of Cardiology Liverpool Heart and Chest Hospital Thomas Dr Liverpool L14 3PE UK

Department of Cardiology University Hospitals Birmingham NHS Foundation Trust Birmingham UK

Department of Thoracic and Cardiovascular Surgery Heart and Diabetes Centre North Rhine Westphalia University Hospital Ruhr University Bochum Bad Oeynhausen Germany

Division of Cardiology and Structural Heart Diseases Medical University of Silesia Ziolowa 45 47 Katowice 40 635 Poland

Division of Cardiology Department of Medicine 2 Medical University of Vienna Waehringer Guertel 18 20 1090 Vienna Austria

Division of Cardiology University of Ottawa Heart Institute Ottawa Canada

Edwards Lifesciences 18600 Prague Czech Republic

General and Interventional Cardiology Angiology Heart and Diabetes Centre North Rhine Westphalia Bad Oeynhausen Ruhr University Germany

Heart Institute Department of Cardiology Hospital University Germans Trias i Pujol Barcelona Spain

Institute for Pharmacology and Preventive Medicine Cloppenburg Germany

Normandie University UNIROUEN U1096 CHU Rouen Department of Cardiology F 76000 Rouen France

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