Sex differences in echocardiographic left ventricular remodeling and clinical outcomes following transcatheter aortic valve implantation.

BACKGROUND

Sex-related differences in left ventricular (LV) remodeling in response to severe aortic stenosis (AS) and post-transcatheter aortic valve implantation (TAVI) remain unclear. Previous studies have demonstrated inconsistent and discordant findings regarding the relationships between LV remodeling and clinical endpoints across sexes following TAVI. More importantly, it has been shown that females with severe AS are often diagnosed later and less likely to be referred for TAVI.

OBJECTIVES

We sought to evaluate sex-based differences in LV remodeling prior to and after TAVI, and to assess whether these differences were associated with long-term clinical outcomes.

METHODS

We conducted a retrospective study of 977 patients with severe AS undergoing TAVI (2013-2020). Serial echocardiograms were performed at baseline (before TAVI) and at various timepoints post-TAVI. Echocardiographic parameters related to LV remodeling were extracted. Clinical outcomes (myocardial infarction [MI], heart failure hospitalization [HFH], stroke, and survival) were tracked over 10 years.

RESULTS

Compared with males, females had larger baseline indexed LV end-diastolic dimension (26.5 ± 4.0 mm/m2 vs. 25.3 ± 3.5; p < 0.001), lower LV mass index[LVMI] (101.5 ± 28.0 vs. 111.5 ± 30.1 g/m2; p < 0.001), higher left ventricular ejection fraction (59.5 ± 11.13 vs. 53.8 ± 13.5%; p < 0.001), and higher LV filling pressures as indicated by a higher E/e' (18.7 ± 6.9 vs. 15.6 ± 6.2, p < 0.001). However, changes in LVMI, LV chamber size, and diastolic parameters post-TAVI were similar across sexes. Within-group analyses demonstrated that both males and females experienced favorable reverse remodeling in LV mass, LVMI, and wall thicknesses post-TAVI. No significant sex differences were observed in MI, HFH, stroke, or survival post-TAVI.

CONCLUSION

Our results support that males and females present with distinct baseline cardiac phenotypes in the setting of severe AS, but both sexes experience comparable LV reverse remodeling and clinical outcomes post-TAVI. This reinforces the structural and prognostic benefit from TAVI across sexes, underscoring the importance of equitable referral and access to this intervention.