Key result
Elevated pre-TAVR sPAP is linked to increased 5-year mortality in males but not females.
Why the study?
Although pulmonary hypertension in patients with severe aortic valve stenosis is associated with increased mortality after TAVR, there are limited data regarding gender differences in its effect on long-term survival.
Does elevated systolic pulmonary artery pressure predict increased mortality after transcatheter aortic valve replacement differently in males versus females?
Cohort (n=303)
Yes
Does elevated systolic pulmonary artery pressure predict increased mortality after transcatheter aortic valve replacement differently in males versus females?
p-value: p=≤0.001
Elevated systolic pulmonary artery pressure is a significant predictor of premature death after TAVR in men, but not in women, suggesting that pulmonary hypertension should be evaluated critically in men but not serve as an exclusion criterion in women.
May inform sex-specific risk assessment post-TAVR; leaves open confirmation in prospective cohorts.
BACKGROUND: While pulmonary hypertension (PH) in patients with severe aortic valve stenosis (AS) is associated with increased mortality after transcatheter aortic valve replacement (TAVR), there is limited data on gender differences in the effects on long-term survival. OBJECTIVE: The aim of this retrospective, multicenter study was to investigate the prognostic impact of pre-interventional PH on survival of TAVR patients with respect to gender. METHODS: 303 patients undergoing TAVR underwent echocardiography to detect PH prior to TAVR via measurement of systolic pulmonary artery pressure (sPAP). Different cut-off values were set for the presence of PH. The primary endpoint was all-cause mortality at 1, 3 and 5 years. RESULTS: Kaplan-Meier analysis by gender showed that only males exhibited significant increased mortality at elevated sPAP values during the entire follow-up period of 5 years (sPAP ≥ 40 mmHg: p ≤ 0.001 and sPAP ≥ 50 mmHg: p ≤ 0.001 in 1- to 5-year survival), whereas high sPAP values had no effect on survival in females. In Cox regression analysis based on the selected sPAP thresholds, male gender was an independent risk factor for long-term mortality after TAVR in all time courses. CONCLUSION: Male gender was an isolated risk factor for premature death after TAVR in patients with echocardiographic evidence of PH and severe AS. This could mean that, the indication for TAVR should be discussed more critically in men with severe AS and an elevated sPAP, while in females, PH should not be an exclusion criterion for TAVR.
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Boxhammer et al. (2023) conducted a cohort in Severe aortic valve stenosis (n=303). Elevated systolic pulmonary artery pressure (sPAP ≥ 40 mmHg or ≥ 50 mmHg) vs. sPAP < 40 mmHg or < 50 mmHg was evaluated on All-cause mortality at 1, 3 and 5 years (p=≤0.001). Elevated systolic pulmonary artery pressure significantly increased 1- to 5-year mortality after transcatheter aortic valve replacement in males, but had no effect on survival in females.