Sex Differences in Reverse Left Ventricular Remodeling in Patients Who Underwent Transcatheter Aortic Valve Replacement in a Chinese Population.

Abstract

Background: Differences between female and male patients may influence the outcomes of transcatheter aortic valve replacement (TAVR). However, knowledge regarding known sex differences in TAVR procedures among Chinese people remains limited. Therefore, this study aimed to investigate the impact of sex-related differences on reverse left ventricular (LV) remodeling following TAVR in the Chinese population.

Methods: Patients with severe symptomatic aortic stenosis (AS) who underwent TAVR at the Heart Center of the Affiliated Zhongshan Hospital of Dalian University were enrolled. A total of 136 patients who underwent implantation of a self-expandable Venus A valve between 2019 and 2024 were evaluated. We retrospectively compared the clinical outcomes and characteristics of all patients by sex.

Results: In our study, females presented with a smaller body surface area (BSA) (1.68 ± 0.15 m² vs. 1.90 ± 0.14 m², p < 0.001), aortic valve area (AVA) (0.64 ± 0.22 cm² vs. 0.77 ± 0.20 cm², p = 0.003), left ventricular end-diastole diameter (LVEDD) (49.72 ± 7.37 mm vs. 53.33 ± 8.36 mm, p = 0.023), as well as interventricular septum in diastole (IVSD) (12.85 ± 2.19 mm vs. 13.88 ± 2.61 mm, p = 0.034) at baseline. Comparatively, males had larger aortic root structures at baseline and a larger size of valve implantation during the procedure (p < 0.05). However, the indexed AVA was not significantly different between the two groups at baseline. Sex-specific outcomes, particularly AVA, LVEDD, aortic root diameter (AO), and IVSD, were significantly different during each follow-up within the first six months (p < 0.05), indicating that females experienced greater improvements in these echocardiographic characteristics after TAVR. Left ventricular ejection fraction (LVEF) only improved significantly at 1-month follow-up in females compared to males (57.77 ± 7.87% vs. 54.40 ± 8.21%, p = 0.037). Multivariable linear-regression analysis showed that being a female patient (Beta: 10.200; 95% CI: 0.075-20.326; p = 0.048), as well as having a higher IVSD (Beta: 2.939; 95% CI: 1.110-4.769; p = 0.002), and higher baseline left ventricular mass index (LVMi) (Beta: 0.409; 95% CI: 0.298-0.521; p < 0.001) were independently associated with greater mid-term LVMi regression post-TAVR.

Conclusions: Female patients with AS exhibited more favorable mid-term LV reverse remodeling post-TAVR compared to male patients in a Chinese population.