经 TAVR 治疗的主动脉瓣狭窄患者上游心脏损伤的性别差异。

Sex-Specific Differences in Upstream Cardiac Damage in Patients With Aortic Stenosis Undergoing TAVR.

机构信息

Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. Electronic address: https://twitter.com/masaaki0825.

Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

出版信息

JACC Cardiovasc Interv. 2024 May 27;17(10):1252-1264. doi: 10.1016/j.jcin.2024.03.031.

DOI:10.1016/j.jcin.2024.03.031

PMID:38811107

Abstract

BACKGROUND

Cardiac damage caused by aortic stenosis (AS) can be categorized into stages, which are associated with a progressively increasing risk of death after transcatheter aortic valve replacement (TAVR).

OBJECTIVES

The authors investigated sex-related differences in cardiac damage among patients with symptomatic AS and the prognostic value of cardiac damage classification in women and men undergoing TAVR.

METHODS

In a prospective registry, pre-TAVR echocardiograms were used to categorize patients into 5 stages of cardiac damage caused by AS. Differences in the extent of cardiac damage were compared according to sex, and its implications on clinical outcomes after TAVR were explored.

RESULTS

Among 2,026 patients undergoing TAVR between August 2007 and June 2022 (995 [49.1%] women and 1,031 [50.9%] men), we observed sex-specific differences in the pattern of cardiac damage (women vs men; stage 0: 2.6% vs 3.1%, stage 1: 13.4% vs 10.1%, stage 2: 37.1% vs 39.5%, stage 3: 27.5% vs 15.6%, and stage 4: 19.4% vs 31.7%). There was a stepwise increase in 5-year all-cause mortality according to stage in women (HR: 1.43; 95% CI: 1.28-1.60, for linear trend) and men (HR: 1.26; 95% CI: 1.14-1.38, for linear trend). Female sex was associated with a lower 5-year mortality in early stages (stage 0, 1, or 2) but not in advanced stages (stage 3 or 4).

CONCLUSIONS

The pattern of cardiac damage secondary to AS differed by sex. In early stages of cardiac damage, women had a lower 5-year mortality than men, whereas in more advanced stages, mortality was comparable between sexes. (SwissTAVI Registry; NCT01368250).

摘要

背景

主动脉瓣狭窄（AS）引起的心脏损伤可分为多个阶段，这些阶段与经导管主动脉瓣置换术（TAVR）后死亡风险的逐渐增加有关。

目的

作者研究了有症状 AS 患者中心脏损伤的性别相关差异，以及 TAVR 中女性和男性患者心脏损伤分类的预后价值。

方法

在一项前瞻性注册研究中，使用 TAVR 前的超声心动图将患者分为 AS 引起的心脏损伤的 5 个阶段。根据性别比较心脏损伤程度的差异，并探讨其对 TAVR 后临床结局的影响。

结果

在 2007 年 8 月至 2022 年 6 月期间接受 TAVR 的 2026 例患者中（女性 995 例[49.1%]，男性 1031 例[50.9%]），我们观察到心脏损伤模式存在性别特异性差异（女性与男性；0 期：2.6%比 3.1%，1 期：13.4%比 10.1%，2 期：37.1%比 39.5%，3 期：27.5%比 15.6%，4 期：19.4%比 31.7%）。女性（HR：1.43；95%CI：1.28-1.60，线性趋势）和男性（HR：1.26；95%CI：1.14-1.38，线性趋势）的 5 年全因死亡率均随阶段的升高而逐渐增加。女性在早期阶段（0 期、1 期或 2 期）的 5 年死亡率较低，但在晚期阶段（3 期或 4 期）则无此差异。