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

Aortic stenosis (AS) is a common and serious valvular disease in older adults, often leading to increased left ventricular mass (LVM) due to pressure overload. Excessive LVM is linked to adverse outcomes, but its sex-specific prognostic significance remains unclear. Focusing on sex-based differences, this study evaluated the left ventricular mass index (LVMi) prognostic value in patients with symptomatic severe AS. We retrospectively analyzed 531 outpatients (283 men, 248 women; mean age 74.7 years) with symptomatic but stable severe AS and no prior valve procedures. Clinical and echocardiographic data were collected between April 2020 and February 2024, with a mean follow-up of 2.67 years. A total of 165 patients (31.1%) died during follow-up, 86% from cardiovascular causes. Deceased patients had lower ejection fraction and higher LVMi. Multivariate Cox analysis identified LVMi and atrial fibrillation (AF) as independent predictors of mortality, while valve intervention predicted survival. In women, both LVMi and AF predicted mortality; valve intervention was protective. In men, only the lack of valve intervention predicted death. Elevated LVMi was a strong predictor of mortality in non-operated patients, with the most pronounced impact observed in women with severe AS.