Timely recognition of AS after diagnostic TTE is essential for appropriate clinical management. This analysis shows that women are less likely than men to receive a coded diagnosis despite similar disease severity on imaging. A study in JACC: Advances examined sex-specific differences in the confirmation of clinically significant AS following TTE across a large multicenter administrative database.

The cohort included 2,036 patients (48.9% women and 51.1% men) with at least moderate AS on TTE. Clinical recognition was defined as assignment of an International Classification of Diseases (ICD) code for AS within one year of the scan. Fine-Gray competing risk models assessed cumulative diagnosis rates across AS severity and phenotype.

The overall 1-year clinical recognition rate for at least moderate AS was 52.4%. Women were less likely than men to receive a diagnosis (48.9% vs 55.7%; P = 0.003). Among individuals with severe AS, the gap widened in severe low-gradient disease, where women had lower recognition than men (54.3% vs 66.9%). Recognition of severe high-gradient AS also trended lower in women, although differences were less pronounced.

The findings indicate persistent sex disparities in the clinical recognition of TTE-confirmed AS. Under-diagnosis is most evident in severe low-gradient AS, a phenotype already known to present diagnostic challenges. Improving diagnostic vigilance, especially for women, may help reduce delays in evaluation and treatment.