Sex differences in prognostic significance of right ventricular-pulmonary artery coupling prior to transcatheter aortic valve replacement

Aortic stenosis (AS) is the most prevalent valve disorder in developing countries, with transcatheter aortic valve replacement (TAVR) being a common treatment option for patients with severe AS. Research indicates that right ventricular (RV) function plays a critical role in predicting adverse outcomes.

This study aims to assess sex differences in prognostic significance of right ventricular (RV) function, evaluated through RV-pulmonary artery (PA) coupling, in predicting all-cause mortality in patients with severe aortic stenosis (AS) following transcatheter aortic valve replacement (TAVR).

We conducted a retrospective cohort study involving patients with severe AS who underwent TAVR at a referral center between 2016 and 2022. Pre-procedural RV function was assessed using conventional parameters and RV-free wall longitudinal strain. RV-PA coupling was evaluated using the tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) <0.36 mm/mmHg ratio and the RV-free wall longitudinal strain/PASP <0.74%/mmHg ratio (RVFWLS/PASP). The primary outcome was all-cause mortality up to 2 years.

A total of 67 patients who underwent TAVR were included 42% women and 58% men. Five patients died in the follow-up period. Median left ventricular ejection fraction was 57 (48-61 %). Demographic and echocardiographic characteristics are shown in the Table 1. Kaplan Meier survival curves demonstrated lower survival rated in patients withTAPSE/PASP <0.36 mm/mmHg (p=0.023), when stratifying by sex it demonstrated to be a better indicator for men than for women (p=0.6 vs p=0.003). Also, RVFWLS/PASP <0.74%/mmHg ratios is a mortality indicator (p=0.020) and it is a better indicator for males than for females mortality (p=0.068 vs p=0.2) (Figure 1).

Pre-procedural RV-PA coupling, as assessed by the TAPSE/PASP ratio (<0.36 mm/mmHg) and RVFWLS/PASP ratio (<0.74%/mmHg), predicted increased risk of all-cause mortality at 2 years post-procedure. However, ventricular-arterial coupling is a better prognostic marker in men before TAVI. This study makes evident the need to look for other unconventional parameters of right ventricular function in women.Table 1.Figure 1.