What is the clinical evidence from this study?

Study design: Cohort. Population: Severe aortic stenosis (n=459). Intervention: Male sex vs. Female sex. Primary outcome: All-cause mortality (HR 1.423, 95% CI 1.039-1.951, p=0.028).

April 21, 2022Open Access

Interaction between sex and left ventricular reverse remodeling and its association with outcomes after transcatheter aortic valve implantation

Key Result

Male sex was independently associated with a higher risk of all-cause mortality after TAVI compared to female sex (HR 1.423), and this survival difference was not explained by sex differences in left ventricular reverse remodeling.

Study Design

Type

Cohort (n=459)

Multicenter

Structured PICO

Does sex influence left ventricular reverse remodeling and all-cause mortality in patients with severe aortic stenosis undergoing TAVI?

Population

459 patients with severe aortic stenosis (mean age 80 years, 48% female) who underwent transfemoral TAVI, followed for a median of 2.8 years.

Exposure

Transfemoral transcatheter aortic valve implantation (TAVI) using balloon-expandable or self-expandable valves

Comparator

Comparison between male and female sexes (both groups received TAVI)

Outcome

All-cause mortality at median 2.8 years follow-uphard clinical

Women have better long-term survival after TAVI compared to men, but this survival benefit is not explained by sex differences in left ventricular reverse remodeling, which occurs similarly in both sexes.

Main Result

Hazard Ratio: 1.423 (95% CI 1.039–1.951)

p-value: p=0.028

Limitations

Single-center retrospective analysis with inherent limitations related to the study design
Only patients with echocardiographic follow-up after TAVI were included, which may have introduced a selection bias
Echocardiographic follow-up was limited to 1 year, whereas LV reverse remodeling may continue beyond 1 year
Arterial afterload and myocardial fibrosis may affect LV reverse remodeling after TAVI but were not fully assessed

Abstract

Abstract Women with severe aortic stenosis (AS) have better long-term prognosis after transcatheter aortic valve implantation (TAVI) compared to men. Whether this is caused by sex-related differences in left ventricular (LV) reverse remodeling after TAVI is unknown. Patients with severe AS who underwent transfemoral TAVI between 2007 and 2018 were selected. LV dimensions, volumes, and ejection fraction (LVEF) were assessed by transthoracic echocardiography before TAVI and at 6 and 12 months follow-up after TAVI. LV reverse remodeling was defined as the percentual LV mass index (LVMi) reduction compared to baseline. The primary outcome was all-cause mortality. A total of 459 patients (80 ± 8 years; 52% male) were included. At 6 and 12 months follow-up, both sexes showed significant reductions in LV volumes and LVMi accompanied by improvement in LVEF, without significant differences between the sexes over time. During a median follow-up of 2.8 IQR 1.9–4.3 years, 181 (39%) patients died. Women showed better outcomes compared to men (log-rank p = 0.024). In addition, male sex was independently associated with all-cause mortality in multivariable Cox regression (HR 1.423, 95% CI 1.039–1.951, p = 0.028). No association was observed between the interaction of percentual LVMi reduction and sex with outcomes (p = 0.64). Men and women with severe AS had similar improvement in LVEF, and similar reductions in LV volumes and LVMi at 6 and 12 months after TAVI. Women showed better survival after TAVI as compared to men. The superior outcomes noted in women after TAVI are not associated with sex differences in LV reverse remodeling. Graphical abstract

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