Sex Differences Among Patients With Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement: A...

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Medical Imaging

Background:

• Severe aortic stenosis (AS) affects cardiac function and patient outcomes.
• Transcatheter aortic valve replacement (TAVR) is a key treatment for severe AS.
• Understanding gender-specific differences in cardiac function post-TAVR is crucial for optimizing patient care.

Purpose of the Study:

• To investigate sex-based disparities in cardiac function following TAVR for severe AS.
• To identify clinical implications of these gender differences on patient outcomes.
• To determine predictors of cardiovascular events in male and female TAVR recipients.

Main Methods:

• Retrospective analysis of 514 patients who underwent successful TAVR for severe AS.
• Exclusion of patients on hemodialysis, those with valve-in-valve procedures, or unsuccessful TAVR.
• Comparison of cardiac function indices, remodeling parameters, and clinical outcomes between sexes.

Main Results:

• Female patients had smaller physiques, fewer comorbidities, and smaller cardiac structures (left ventricle, aortic valve) even after physique correction.
• Women exhibited impaired left ventricular diastolic function (e.g., increased left atrial volume index [LAVI], E/e') and more advanced left ventricular remodeling (e.g., increased relative wall thickness [RWT]).
• While 1-year outcomes were similar, predictors for cardiovascular events differed: clinical frailty, LAVI, and RWT in women; atrial fibrillation and past smoking in men.

Conclusions:

• Women undergoing TAVR present with worse left ventricular diastolic function and remodeling compared to men.
• These cardiac differences significantly impact TAVR outcomes in female patients.
• Timely and potentially earlier interventions may be particularly beneficial for women receiving TAVR.