SPC365

Sex-related Differences in Conduction Disturbances After Transcatheter Aortic Valve Implantation

Session: Sessão de Posters 57 - Diferenças de género em Cardiologia
Speaker: Ana Isabel Pinho

Congress: CPC 2024
Topic: J. Preventive Cardiology
Theme: 28. Risk Factors and Prevention
Subtheme: 28.14 Risk Factors and Prevention - Other
Session Type: Cartazes
FP Number: ---
Authors: Ana Isabel Pinho; Catarina Amaral Marques; Cátia Oliveira; Luís Daniel Santos; André Cabrita; Teresa Pinho; Fábio Trindade; Isabel Miranda; Adelino Leite Moreira; Marta Tavares Silva; Carla Sousa; Rui André Rodrigues

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Introduction: Considerable advances in procedural techniques are leading to the extension of Transcatheter Aortic Valve Implantation (TAVI) indications. However, atrioventricular conduction disturbances (CD) requiring permanent pacemaker implantation (PPMI) are&nbsp;a frequent and relevant complication after TAVI. Current data on the prognostic impact of sex on outcomes after TAVI are&nbsp;conflicting. Recent studies showed favorable outcomes in women after TAVI, and updating data on sex differences in CD and PPMI is crucial.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Aim: To determine the prognostic impact of sex among patients (pts) presenting with CD and requiring PPMI post-TAVI.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Methods: Sixty pts who underwent transfemoral elective TAVI between November 2021 and November 2023 and who provided&nbsp;written consent were included. Exclusion criteria included previous pacemaker device, atrial fibrillation, stage 5 chronic kidney failure, non-revascularized ischemic heart disease and active autoimmune or neoplastic disease. Data were prospectively collected. The primary endpoint was development of de novo CD after&nbsp;TAVI and need for PPMI.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Results: Of the 60 pts (mean age 81&plusmn;5, mean BMI 27.9&plusmn;4.6 kg/m<sup>2</sup>, mean LVEF 62&plusmn;8%, 97% in NYHA class &ge;II), 41 (68%) were women and 19 (32%) were men. As expected, compared with men, women had lower aortic valve calcium score from pre-TAVI computed tomography (2735&plusmn;1113 versus 3955&plusmn;1346, p&lt;0.001); the remaining baseline characteristics and procedural details were similar between the sexes, except for chronic use of diuretics (table 1). </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Prevalence of in-hospital intercurrences, including stroke, vascular or valvular complications, new CD, need for PPMI, acute kidney injury and infection, was lower in women (44% vs 79%, odds ratio [OR] 0.09, 95% confidence interval [CI] 0.01-0.91; p=0.04); particularly development of new CD (20% vs 58%; OR 0.18, 95% CI 0.05-0.58; p=0.004) and PPMI (17% vs 42%; OR 0.28, 95% CI 0.83-0.96; p=0.043). Hospital length of stay showed a trend toward increased duration of hospitalization in men, without reaching statistical significance (5 [IQR 3] days for women vs 6 [IQR 6] days for men, p=0.056). </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Mean follow-up time was 11&plusmn;8 months for the entire cohort. During follow-up, 6 pts suffered an intercurrence, including stroke, need for PPMI and rehospitalization for heart failure or kidney failure: 4 women (10%) and 2 men (11%) (p=0.899).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Conclusion: In our study, there were significant sex-related disparities in intercurrences during hospitalization after TAVI, including CD. </span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">No significant differences were noted in follow-up outcomes between men and women. Our data revealed that, while there were more women than men undergoing TAVI, men had a 5.7 higher odd of developing post-TAVI CD and a 3.5 higher odd of needing PPMI than women. The susceptibility to conduction disturbances requiring PPMI in men warrants further investigation and should be recognized as the indications for TAVI expand.</span></span></span></span></p>