부산대학교 도서관

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.