Sex-related differences in left atrial and right ventricular remodelling and function in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation
Authors: Botezatu B S , Calin A , Parasca C , Beladan C C , Enache R , Rosca M , Nita B , Deleanu D , Chioncel O , Iliescu V , Popescu B A 
Published: January 2025

Abstract

Background
Sex-specific differences in aortic stenosis(AS) regarding the underlying pathophysiological mechanisms affecting the valve and left ventricular(LV) response to pressure overload are well recognised. Data on differences in left atrial(LA) and right heart remodelling and function between men and women with AS are scarce.

Purpose
To investigate sex-related differences in LA and right ventricular(RV) remodelling and function echocardiographic parameters in AS patients(pts) and their association with long term all-cause mortality after TAVI.

Methods
Fifty-seven women and 57 men with severe AS undergoing TAVI, matched to be similar with respect to age(77±6 vs 78±6 yrs,p=0.67) and LV ejection fraction(55±10 vs 54±8%,p=0.22) were enrolled and examined before and 30 days after TAVI. All pts underwent a comprehensive echocardiogram, including speckle tracking echocardiography (STE) for deformation analysis. Peak values of global longitudinal LA strain(LAε), LA systolic strain rate(SSr, reservoir function) and early diastolic strain rate(ESr, conduit function) were measured in all. Contractile LA function(late diastolic strain rate, ASr) was assessed in pts in sinus rhythm(89 pts).

Results
At baseline, the degree of LA dilation in female pts was higher(indexed LA volume(LAVi): 54.1±12.4 vs 47.9±16.7 ml,p=0.028), global longitudinal LA strain(12.6±6.2 vs 13.7±7.1%), SSr(0.6±0.3 vs 0.7±0.3) and ESr(-0.4±0.3 vs -0.5±0.3) were similar in men and women(all p values &gt;0.05), while women had worse contractile LA function(ASr: -0.9±0.5 vs -1.2±0.6,p=0.034). Women also had a less dilated RV(32±5 vs 35±5mm,p=0.012) and better RV global systolic function(fractional area change, FAC: 44±8 vs 40±6%,p=0.012). A significant improvement in LA volumes, global LA strain, SSr and ESr 30 days after TAVI was observed in both men and women, while the contractile LA function improved only in men. The RV parameters that significantly improved after TAVI were the RV-free wall S wave in both men(p&lt;0.001) and women(p=0.003) and the 6-segments RVLS in women(p=0.037)(Figure 1). During follow-up(4.2±0.7yrs), death occurred in 27 pts(23.7%). Although 1-year and 3-year survival rates were higher in women, 5-year survival rate was similar in both groups(Figure 2). In female pts, the predictors for all-cause mortality were baseline RV-free wall S wave(p=0.045) and LAVi(p=0.036), and after-TAVI LAVi(p=0.023), while in male pts the only predictors were global longitudinal LA strain at baseline(p=0.036) and after-TAVI(p=0.016).

Conclusions
AS is associated with significant differences in LA and RV response between men and women, with women exhibiting a more significant LA dilatation, poorer LA contractile function, less dilated RV and better RV global systolic function. TAVI is associated with a significant recovery of LA dimensions and function in both men and women, suggesting reverse remodelling, although men show a more significant improvement in LA contractile function.
Figure 1
Figure 2