Sex differences in reverse remodeling after transcatheter aortic valve replacement in low-flow aortic stenosis.

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Invasive Cardiology Pub Date : 2026-10-01 DOI:10.25270/jic/26.00117

Eileen Galvani, Oludamilola Akinmolayemi, Philippe Pibarot, Sébastien Hecht, Roya Anahita Mousavi, Yash Prakash, Esha Vaish, Samin K Sharma, Annapoorna S Kini, Marie-Annick Clavel, Stamatios Lerakis

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引用次数: 0

Abstract

Objectives: Sex-specific differences in left ventricular (LV) remodeling after transcatheter aortic valve replacement (TAVR) in low-flow aortic stenosis (LFAS) remain incompletely defined, and the influence of LFAS subtype on remodeling by sex is uncertain. The authors sought to characterize post-TAVR remodeling in LFAS by sex and subtype and identify predictors of remodeling.

Methods: This retrospective cohort study included 488 patients with LFAS (303 men, 185 women) who underwent TAVR. Smoothed conditional mean curves assessed longitudinal changes in LV mass index (LVMi), relative wall thickness (RWT), and LV ejection fraction (LVEF) through 18 months. Linear mixed models identified predictors of remodeling.

Results: Women more often had paradoxical low-flow low-gradient (pLFLG) AS (58.4% vs 43.6%, P = .001), whereas men more often had classical low-flow low-gradient AS (31.4% vs 13.5%, P < .001). At 1 year, both sexes showed significant improvement in LVMi, RWT, and LVEF. Men demonstrated sustained improvement in LVEF and LVMi during follow-up, whereas women showed earlier improvement followed by decline beginning around 12 months. Predictors also differed: lower LVMi after TAVR was associated with White race and less severe baseline mitral regurgitation in men, and with pLFLG subtype in women.

Conclusions: Reverse remodeling after TAVR occurred in both sexes, but trajectories and predictors were sex-specific.

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低流量主动脉瓣狭窄经导管主动脉瓣置换术后反向重构的性别差异。

目的：低流量主动脉瓣狭窄（LFAS）经导管主动脉瓣置换术（TAVR）后左室（LV）重构的性别差异尚不完全明确，LFAS亚型对性别重构的影响尚不确定。作者试图通过性别和亚型来描述LFAS中tavr后重构的特征，并确定重构的预测因素。方法：本回顾性队列研究纳入488例LFAS患者（303例男性，185例女性）。平滑的条件平均曲线评估了18个月内左室质量指数（LVMi）、相对壁厚（RWT）和左室射血分数（LVEF）的纵向变化。线性混合模型确定了重塑的预测因子。结果：女性更常发生矛盾低流量低梯度AS (pLFLG) (58.4% vs 43.6%, P = .001)，而男性更常发生经典低流量低梯度AS （31.4% vs 13.5%, P < .001）。1年后，男女LVMi、RWT和LVEF均有显著改善。在随访期间，男性表现出LVEF和LVMi的持续改善，而女性表现出较早的改善，随后在12个月左右开始下降。预测指标也存在差异：TAVR后LVMi较低与白人有关，男性基线二尖瓣返流较轻，女性与pLFLG亚型有关。结论：TAVR后的逆转重构发生在两性中，但轨迹和预测因素是性别特异性的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Invasive Cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

2.90

自引率

6.70%

发文量

214

审稿时长

3-8 weeks

期刊介绍： The Journal of Invasive Cardiology will consider for publication suitable articles on topics pertaining to the invasive treatment of patients with cardiovascular disease.