Effect of Sex on Mortality and Left Ventricular Remodeling After Transcatheter Aortic Valve Implantation
Koki Shishido, Futoshi Yamanaka, Tomoki Ochiai, Noriaki Moriyama, Hiroaki Yokoyama, Shohei Yokota, Kenichiro Noguchi, Fumiaki Yashima, Norio Tada, Toru Naganuma, Motoharu Araki, Shinichi Shirai
the effects sex differences on LVMI in severe AS. Relief of mechanical obstruction for severe AS by surgical aortic valve replacement (SAVR) leads to hemodynamic improvement and a substantial decrease in LV mass, corresponding to a decrease in cardiovascular risk. 4-6 Regression of LV mass occurs early after SAVR and continues up to 10 years after surgery. LV responses according to sex C hronic left ventricular (LV) pressure overload caused by aortic stenosis (AS) leads to a hypertrophic
... e from the myocardium. An accurate LV hypertrophy (LVH) assessment plays an important role in evaluating the prognosis of severe AS patients. 1 Moreover, LVH, as determined by LV mass or the LV mass index (LVMI), is an independent predictor of adverse cardiovascular events in patients with AS. 2 The magnitude of LV hypertrophic remodeling is affected not only by AS, but also by sex. Background: The effect of sex on mortality is controversial; furthermore, sex differences in left ventricular (LV) remodeling after transcatheter aortic valve implantation (TAVI) remain unknown. Methods and Results: This study included 2,588 patients (1,793 [69.3%] female) enrolled in the Optimized CathEter vAlvular iNtervention (OCEAN)-TAVI Japanese multicenter registry between October 2013 and May 2017. We retrospectively analyzed the effect of sex on mortality, and evaluated changes in the LV mass index (LVMI) after TAVI. Female sex was significantly associated with lower all-cause and cardiovascular mortality (log-rank P<0.001 for both). Multivariate analysis showed that female sex was independently associated with lower cumulative long-term mortality (hazard ratio 0.615; 95% confidence interval 0.512-0.738; P<0.001). Regression in the LVMI was observed in both sexes, and there was no significant difference in the percentage LVMI regression from baseline to 1 year after TAVI between women and men. Women had a survival advantage compared with men among patients with LVMI regression at 1 year, but not among patients with no LVMI regression. Conclusions: We found that female sex is associated with better survival outcomes after TAVI in a large Japanese registry. Although LVMI regression was observed in women and men after TAVI, post-procedural LV mass regression may be related to the sex differences in mortality.