Women live longer after TAVR than men
Women are associated with better long-term survival after transcatheter aortic valve replacement (TAVR) than men, according to new data published in Heart, Lung and Circulation.[1]
“Although TAVR is the guideline-recommended mode of treatment for patients aged ≥75 years and those <75 years at high surgical risk, procedural risks remain a cause of concern,” wrote first author Daanyaal Wasim, MD, PhD, a heart disease specialist with Haukeland University Hospital in Norway, and colleagues. “Additionally, the short-term cost of TAVR is higher than that of surgery, making careful selection of patients who will benefit from this treatment essential. Understanding and improving the baseline patient profile is crucial to achieve the proven benefits of TAVR in low- and intermediate-risk patients.”
Wasim et al. explored data from 600 patients who underwent TAVR at a high-volume facility in Norway from 2012 to 2019. All patients presented with severe aortic stenosis (AS). The mean age was nearly 81 years old, and 51% of patients were men. Echocardiograms (ECGs) was performed at baseline, immediately after treatment, after one month and again after six months.
Overall, women undergoing TAVR were slightly older and more likely to present with hypertension, basal septal hypertrophy or a high left ventricular ejection fraction (LVEF) than men. On the other hand, women were less likely to present with diabetes, cardiovascular disease, an abnormal ECG or atrial fibrillation (AFib).
During a mean follow-up period of approximately five years, 125 women and 154 men had died. There was no different in survival for the first two years, but then women were linked to a higher survival rate after three years and beyond. A multivariable Cox regression analysis of two propensity-matched patient groups found that long-term, event-free survival was significantly higher for women than men.
The authors also worked to learn more about the clinical significance of abnormal ECGs results.
“An abnormal ECG at baseline was more common among men and strongly associated with all-cause mortality in the univariate model,” they wrote. “Interestingly, in the multivariable-adjusted model, it was AFib, but not overall abnormal ECG, that strongly and independently predicted mortality. AFib is likely an indicator of higher burden of comorbidities.”
In their analysis, Wasim and colleagues explored potential explanations for this survival benefit among women after TAVR. One potential reason may have to do with how men and women respond to left ventricular remodeling.
“It has been postulated that female patients tolerate concentric left ventricular hypertrophy (LVH) secondary to AS for longer durations compared with male patients, who are more likely to have eccentric LVH and dilated cardiomyopathy,” the group explained. “In our study, observed sex differences in baseline echocardiographic and ECG findings included higher prevalence of concentric LVH and preserved LVEF, narrower QRS, and less frequent AFib among women than men. These differences further support the notion that women inherently carry a lower risk of mortality, not solely explained by the conventional factors, and reflect a sex-specific pattern of left ventricular remodeling that is less susceptible to transition from concentric to eccentric left ventricular geometry. This process may occur more frequently and earlier in men, leading to loss of cardiac contractility. Hence, better preservation of cardiac contractile reserve, adaptive remodeling, and less left ventricular fibrosis before TAVR in women may explain the improved outcome.”
The authors also noted that women have lower concentrations of periostin, “a key regulator of cardiac fibrosis associated with increased risk of cardiac mortality.”
Click here to read the full analysis in Heart, Lung and Circulation, a journal from the Australian and New Zealand Society of Cardiac and Thoracic Surgeons and Cardiac Society of Australia and New Zealand.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.