Wang Changjin, Yang Bangyuan, Luo Songyuan, Zheng Shengneng, Sun Yinghao, Chen Jiaohua, Fan Ruixin, Luo Jianfang, Li Jie
Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People's Republic of China.
Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People's Republic of China.
Int J Gen Med. 2024 Aug 28;17:3755-3764. doi: 10.2147/IJGM.S452034. eCollection 2024.
The relationship between pulmonary hypertension (PH) and outcomes after transcatheter aortic valve replacement (TAVR) has been shown to be unfavorable. The impact of gender on TAVR outcomes remains controversial. There have been no studies evaluating the simultaneous effects of both factors on TAVR outcomes.
We retrospectively analyzed a prospective cohort of patients who underwent TAVR between January 2016 and December 2022. The patients were stratified by gender and the presence of PH. The primary outcome of the study was all-cause mortality. Secondary outcome was a composite of all-cause mortality and heart failure hospitalization.
We identified a total of 133 female patients without PH, 179 males without PH, 87 females with PH, and 122 males with PH. The median follow-up period was 18 months. Female patients without PH demonstrated a lower cumulative mortality rate compared to those with male gender and/or PH. Adjusted multivariate Cox proportional hazard analyses revealed that male gender and PH status, either individually or in combination, were independently associated with long-term mortality when compared to female patients without PH. Specifically, females with PH (HR 6.80, 95% confidence interval (CI): 1.49-31.12, P=0.013), males without PH (HR 6.45, 95% CI: 1.47-28.22, P=0.013), and males with PH (HR 7.2, 95% CI: 1.63-31.81, P=0.009) demonstrated significantly higher risk for mortality.
Patients who were male or had PH status had a higher risk of mortality. However, there was no synergistic effect between being male and having PH on the prognosis after TAVR.
肺动脉高压（PH）与经导管主动脉瓣置换术（TAVR）后的预后关系已显示不佳。性别对TAVR预后的影响仍存在争议。尚无研究评估这两个因素对TAVR预后的同时影响。
我们回顾性分析了2016年1月至2022年12月期间接受TAVR的前瞻性队列患者。患者按性别和是否存在PH进行分层。研究的主要结局是全因死亡率。次要结局是全因死亡率和心力衰竭住院的综合情况。
我们共确定了133例无PH的女性患者、179例无PH的男性患者、87例有PH的女性患者和122例有PH的男性患者。中位随访期为18个月。无PH的女性患者与男性和/或有PH的患者相比，累积死亡率较低。调整后的多变量Cox比例风险分析显示，与无PH的女性患者相比，男性性别和PH状态单独或联合起来均与长期死亡率独立相关。具体而言，有PH的女性（风险比[HR] 6.80，95%置信区间[CI]：1.49 - 31.12，P = 0.013）、无PH的男性（HR 6.45，95% CI：1.47 - 28.22，P = 0.013）和有PH的男性（HR 7.2, 95% CI：1.63 - 31.81，P = 0.009）的死亡风险显著更高。
男性或有PH状态的患者死亡风险较高。然而，男性和有PH对TAVR后预后没有协同作用。
