Sex-specific differences in cardiac damage among patients undergoing TAVI

Abstract

Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): EACVI Training Grant App000073275. Background Aortic stenosis (AS) is the most common valvular heart disease in developed countries and when indicated can be treated with transcatheter aortic valve implantation (TAVI). Recently, a cardiac damage staging (including the left ventricle, the left atrium and mitral regurgitation, the pulmonary pressures and tricuspid regurgitation, and finally the right ventricle, Figure 1) has been proposed in severe AS to optimize risk stratification, but there is still paucity of data about potential sex-differences for this classification. Purpose to identify differences between men and women in cardiac damage before and after TAVI, and evaluate the potential prognostic value. Methods A total of 734 patients with severe AS undergoing TAVI were included. Demographic and clinical data were collected before TAVI. Echocardiography was performed before and 6 months after TAVI, and patients were hierarchically classified in a given cardiac damage stage (worst stage) if at least one of the proposed criteria was met (Figure 1). The primary endpoint was all-cause mortality at long-term follow-up (3.2 years ± 1.3 starting from the 6 months follow-up echocardiography). Results At baseline women (n=334, 45%) were older (81.3 ± 6.7 years vs 78.5 ± 7.7 years, p<0.0001), had fewer cardiovascular risk factors but higher heart rate and blood pressure compared to men. By echocardiography before TAVI, cardiac damage distribution was overall comparable (p = 0.056) between men and women although women showed higher percentage of patients in stage 3 (p<0.05, Figure 2). After TAVI, an improvement in cardiac damage staging was observed with less patients in stage 3 and 4, but a significant difference (p<0.0001) was observed between men and women, having women still more patients in stage 3 (p<0.05) and men more patients in stage 4 (p<0.05) (Figure 2). During long-term follow-up, 206 events occurred (n=79 in women and n=127 in men) and Kaplan-Meier curve analysis illustrated that women had better survival than men (Log-rank p = 0.018; Chi-square 5.642) after TAVI. However, in the multivariate cox regression analysis, at each increment of cardiac damage stage women had higher increased risk for all-cause mortality (HR 1.480, CI 1.143–1.914, p = 0.003) as compared to men (HR 1.206, CI 1.002–1.451, p = 0.003) after adjusting for significant clinical covariates. Conclusions Women and men with severe AS present different cardiac damage staging namely after treatment with TAVI. Although women show better survival after TAVI, cardiac damage staging is of important prognostic value in both sex.