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Titel:

Sex-Related Differences in Clinical Characteristics and Outcome Prediction Among Patients Undergoing Transcatheter Tricuspid Valve Intervention.

Dokumenttyp:
Article; Multicenter Study; Journal Article
Autor(en):
Fortmeier, Vera; Lachmann, Mark; Körber, Maria I; Unterhuber, Matthias; Schöber, Anne R; Stolz, Lukas; Stocker, Thomas J; Kassar, Mohammad; Gerçek, Muhammed; Rudolph, Tanja K; Praz, Fabien; Windecker, Stephan; Pfister, Roman; Baldus, Stephan; Laugwitz, Karl-Ludwig; Hausleiter, Jörg; Lurz, Philipp; Rudolph, Volker
Abstract:
BACKGROUND: Men and women differ regarding comorbidities, pathophysiology, and the progression of valvular heart diseases. OBJECTIVES: This study sought to assess sex-related differences regarding clinical characteristics and the outcome of patients with severe tricuspid regurgitation (TR) undergoing transcatheter tricuspid valve intervention (TTVI). METHODS: All 702 patients in this multicenter study underwent TTVI for severe TR. The primary outcome was 2-year all-cause mortality. RESULTS: Among 386 women and 316 men in this study, men were more often diagnosed with coronary artery disease (52.9% in men vs 35.5% in women; P = 5.6 × 10-6). Subsequently, the underlying etiology for TR in men was predominantly secondary ventricular (64.6% in men vs 50.0% in women; P = 1.4 × 10-4), whereas women more often presented with secondary atrial etiology (41.7% in women vs 24.4% in men, P = 2.0 × 10-6). Notably, 2-year survival after TTVI was similar in women and men (69.9% in women vs 63.7% in men; P = 0.144). Multivariate regression analysis identified dyspnea expressed as New York Heart Association functional class, tricuspid annulus plane systolic excursion (TAPSE), and mean pulmonary artery pressure (mPAP) as independent predictors for 2-year mortality. The prognostic significance of TAPSE and mPAP differed between sexes. Consequently, we looked at right ventricular-pulmonary arterial coupling expressed as TAPSE/mPAP and identified sex-specific thresholds to best predict survival; women with a TAPSE/mPAP ratio <0.612 mm/mm Hg displayed a 3.43-fold increased HR for 2-year mortality (P < 0.001), whereas men with a TAPSE/mPAP ratio <0.434 mm/mm Hg displayed a 2.05-fold increased HR for 2-year mortality (P = 0.001). CONCLUSIONS: Even though men and women differ in the etiology of TR, both sexes show similar survival rates after TTVI. The TAPSE/mPAP ratio can improve prognostication after TTVI, and sex-specific thresholds should be applied to guide future patient selection.
Zeitschriftentitel:
JACC Cardiovasc Interv
Jahr:
2023
Band / Volume:
16
Heft / Issue:
8
Seitenangaben Beitrag:
909-923
Volltext / DOI:
doi:10.1016/j.jcin.2023.01.378
PubMed:
http://view.ncbi.nlm.nih.gov/pubmed/37100555
Print-ISSN:
1936-8798
TUM Einrichtung:
1038; 606; Klinik und Poliklinik für Innere Medizin I, Kardiologie (Prof. Laugwitz)
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