We are aware of sex related differences when it comes to comorbidities, physiopathology and disease evolution in patients with tricuspid regurgitation (TR).
TR is more prevalent among women, whereas among men, coronary artery disease is more prevalent, with worse left ventricular ejection fraction and 10-year survival rate. Transcatheter tricuspid valve intervention (TTVIs) has surged as a therapeutic option for patients with severe, inoperable TR. Despite the fact that, according to research, women with severe TR are at higher risk of inhospital mortality, no studies have looked into the impact of sex on survival after TTVIs.
The aim of this multicenter study was to assess sex related differences as regards clinical characteristics and outcomes in patients with severe TR undergoing TTVIs.
Primary end point was all cause mortality at 2 years.
The study looked at 702 patients, 55% women and 45% mean. Mean age was 78, Patients often presented dyspnea expressed as NYHA FC III (75.9%) followed by FC IV (14.1%).
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Men presented FC IV dyspnea more often than women (18% in men vs 10% in women, P=0.009). They also presented more coronary artery disease and more pacemaker/cardio-defibrillator.
As regards primary end point, 2-year survival resulted similar when comparing men and women’s outcomes (63.7% in men vs 69.9% in women, P=0.144). After multivariable analysis, dyspnea severity expressed as NYHA FC, TAPSE assessed by echocardiography, and mean pulmonary artery pressure (mPAP) resulted independent predictors of 2-year mortality after TTVIs.
In order to predict mortality at 2 years, they looked at right ventricular–pulmonary arterial coupling expressed as TAPSE/mPAP.
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Women with a TAPSE/mPAP ratio <0.612 mm/mm Hg presented a 3.43-fold increased risk for 2-year mortality (P < 0.001), whereas men with a TAPSE/mPAP ratio <0.434 mm/mm Hg saw a 2.05-fold increased risk for 2-year mortality (P = 0.001).
Conclusion
The underlying etiology of TR differs between men and women, which reflects a different physiopathology. However, TTVIs is equally effective in both sexes, with similar success and survival rates after intervention. Dyspnea severity, pulmonary hypertension and right ventricular dysfunction were independent mortality predictors after TTVIs. This is why TAPSE/mPAP is a good 2-year mortality predictor and should guide intervention time and patient selection optimization.
Dr. Andrés Rodríguez.
Member of the Editorial Board of SOLACI.org.
Original Title: Sex-Related Differences in Clinical Characteristics and Outcome Prediction Among Patients.
Reference: Undergoing Transcatheter Tricuspid Valve Intervention Vera Fortmeier, MD et al J Am Coll Cardiol Intv 2023.
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