Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland.
Int J Cardiovasc Imaging. 2022 Sep;38(9):1973-1985. doi: 10.1007/s10554-022-02596-x. Epub 2022 Apr 21.
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.
患有严重主动脉瓣狭窄（AS）的女性在经导管主动脉瓣植入术（TAVI）后具有更好的长期预后，而男性则不然。这种差异是否是由于 TAVI 后左心室（LV）反向重构的性别差异所致尚不清楚。
本研究入选了 2007 年至 2018 年间接受经股动脉 TAVI 的严重 AS 患者。在 TAVI 前以及 TAVI 后 6 个月和 12 个月时，通过经胸超声心动图评估 LV 尺寸、容量和射血分数（LVEF）。LV 反向重构定义为与基线相比 LV 质量指数（LVMi）的百分比降低。主要结局是全因死亡率。
共纳入 459 例患者（80±8 岁，52%为男性）。在 6 个月和 12 个月的随访中，男性和女性的 LV 容积和 LVMi 均显著降低，LVEF 均得到改善，且两性之间的差异无统计学意义。在中位数为 2.8 年[IQR 1.9-4.3]的随访期间，181 例（39%）患者死亡。女性的预后优于男性（对数秩检验 p=0.024）。此外，多变量 Cox 回归分析显示，男性性别与全因死亡率独立相关（HR 1.423，95%CI 1.039-1.951，p=0.028）。未观察到 LV 反向重构百分比与性别之间的交互作用与结局之间存在关联（p=0.64）。严重 AS 的男性和女性在 TAVI 后 LVEF 均有相似的改善，LV 容积和 LVMi 在 TAVI 后 6 个月和 12 个月时也有相似的降低。与男性相比，女性在 TAVI 后具有更好的生存。在 TAVI 后女性的预后较好与 LV 反向重构的性别差异无关。
