(P126) DIFFERENCES IN RIGHT VENTRICULAR REMODELING AND ITS IMPACT ON SURVIVAL BETWEEN MEN AND WOMEN WITH AORTIC STENOSIS

Background: Current guidelines recommends to treat tricuspid regurgitation/annulus dilation (TR/D) at the time of aortic valve replacement (AVR) for aortic stenosis (AS). However, sex-differences in TR/D and right ventricle (RV) remodeling in AS in patients with AS have not been investigated. We thus aimed to evaluated the sex-differences in TR/D, RV remodeling, as well as their importance on survival after AVR.

METHODS AND RESULTS: We retrospectively analyzed the data of 198 patients with at least mild AS at baseline. AS and TR severity and RV dimensions were assessed by transthoracic echocardiography. Among these patients, 163 underwent an AVR within 3 months and were follow up during 5 +/- 1 years. Mean age was 76+/-12 years, 44% were women. Women presented with more TR than men (p=0.02; Figure). RV dimensions were significantly smaller in women than men (tricuspid annulus diameter: 34.0+/-0.7 vs 36.1+/- 0.5; mid-ventricular diameter: 29.7+/- 0.6 vs 33.1+/-0.6; height: 65.2+/-1.0 vs 73.4+/-0.9, all p≤0.01). However, after indexation to body surface area, tricuspid annulus diameter was larger in women than in men (20.4+/-0.4 vs 18.8+/-0.3, p= 0.002) while other dimensions were similar (Figure). TR≥3 was associated with increased mortality after AVR (HR:1.65 (1.15-2.37); p=0.007), while tricuspid annulus dilation was not (p=0.97). After adjustment by EuroSCORE 2, TR≥3 remained associated with mortality (HR:1.25 [1.08-6.69]; p=0.03; Figure), while dilated tricuspid annulus was not (p=0.52).

Conclusion: Using indexed dimensions is essential to assess RV remodeling in patients with AS. Women appear to have more TR and tricuspid annulus dilation versus men. In turn, moderate / severe TR was associated with reduced survival. These findings may contribute to explain previous reports of worse outcomes in women versus men following surgical AVR.