Abstract 10185: Interaction Between Sex and Left Ventricular Reverse Remodeling and Its Association with Outcome After Transcatheter Aortic Valve Implantation

Circulation, vol. 144

Abstract

Introduction: Women with severe aortic valve 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. Purpose: To examine the interaction between sex and LV reverse remodeling with outcome after TAVI. Methods: Patients with severe AS who had undergone transfemoral TAVI between 2007 and 2018 were selected. LV dimensions, volumes and ejection fraction (LVEF) were assessed by transthoracic echocardiography at baseline before TAVI, and at 6 and 12 months after TAVI. LV reverse remodeling was defined as %LV mass index (LVMi) reduction from baseline. The primary outcome was all-cause mortality. Results: A total of 459 patients (80±8 years; 52% male) were included. Before TAVI, indexed LV end-diastolic and end-systolic volume as well as LVMi were smaller in women versus men. 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 (p for interaction=0.51, p=0.43, p=0.44 and p=0.30, respectively). During a median follow-up of 2.8 [IQR 1.9-4.3] years, 181 (39%) patients died. Women showed better outcome 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 %LVMi reduction and sex with outcome (p=0.64). Conclusions: Patients with severe AS had significant improvement in LVEF, reduction in LV volumes and LVMi at 6 and 12 months after TAVI, without significant differences between sexes over time. Women showed better survival after TAVI as compared to men despite being treated at older age. The interaction between %LVMi reduction and sex was not associated with survival.

Authors 10

1. Jurriën H. Kuneman Aachen Jurrien H Kuneman Leiden Univ Med Cntr

   Leiden University

   Affiliation as printed

   Leiden Univ Med Cntr, Leiden, Netherlands

   Jurrien H Kuneman Leiden Univ Med Cntr, Leiden, Netherlands

2. Steele C. Butcher
   Affiliation as printed

   Leiden

   Steele Butcher Leiden

3. Jan Stassen Aachen Jan Stassen Leiden Univ Med Cntr

   Leiden University

   Affiliation as printed

   Leiden Univ Med Cntr, Leiden, Netherlands

   Jan Stassen Leiden Univ Med Cntr, Leiden, Netherlands

4. Stephan Milhorini Pio Aachen

   Leiden University Medical Center

   Affiliation as printed

   LEIDEN UNIVERSITY MEDICAL CENTER, Leiden

   Stephan Milhorini Pio LEIDEN UNIVERSITY MEDICAL CENTER, Leiden

5. Kensuke Hirasawa
   Affiliation as printed

   Leiden

   Kensuke Hirasawa Leiden

6. Frank van der Kley Aachen

   Leiden University

   Affiliation as printed

   Leiden Univ Med Cntr, Leiden, Netherlands

   Frank van der Kley Leiden Univ Med Cntr, Leiden, Netherlands

7. Nina Ajmone Marsan Aachen

   Leiden University Medical Center

   Affiliation as printed

   LEIDEN UNIVERSITY MEDICAL CENTER, Leiden

   Nina A Ajmone Marsan LEIDEN UNIVERSITY MEDICAL CENTER, Leiden

8. Juhani M. Knuuti

   University of Turku

   Affiliation as printed

   Univ of Turku, Turku, Finland

   Juhani Knuuti Univ of Turku, Turku, Finland

9. Jeroen Joost Bax Aachen

   Leiden University Medical Center

   Affiliation as printed

   LEIDS UNIVERSITY MEDISCH CENTRUM, Leiden, Netherlands

   Jeroen J Bax LEIDS UNIVERSITY MEDISCH CENTRUM, Leiden, Netherlands

10. Victoria Delgado Aachen Victoria Delgado Leiden Univ Med Cntr

    Leiden University · Leiden University Medical Center

    Affiliation as printed

    Leiden Univ Med Cntr, Leiden, Netherlands

    Victoria Delgado Leiden Univ Med Cntr, Leiden, Netherlands