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

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 (2023). Sex-Related Differences in Clinical Characteristics and Outcome Prediction Among Patients Undergoing Transcatheter Tricuspid Valve Intervention. JACC. Cardiovascular Interventions, 16(8), pp. 909-923. Elsevier 10.1016/j.jcin.2023.01.378

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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.

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