Both men and women demonstrate similar survival rates after transcatheter tricuspid valve intervention (TTVI), despite having differences in etiology, a new study shows. These data were reported by Vera Fortmeier, MD, of Ruhr University Bochum, Bad Oeynhausen, Germany, Mark Lachmann, MD, Technical University of Munich and the German Center for Cardiovascular Research, and colleagues from Germany and Switzerland, in a manuscript published Wednesday online in JACC: Cardiovascular Interventions. Diagnosis, comorbidities and progression of disease are different between men and women with valvular heart diseases. Women are more likely to have tricuspid regurgitation (TR), for example. Etiology differences are also noted: men with TR are more frequently diagnosed with coronary artery disease and have worse10-year survival rates compared with women, and women are at greater risk for hospital mortality and increased surgical risk scores. TTVIs are a TR treatment option for patients who are unable to undergo an operation, but no studies have evaluated the sex-related differences in outcomes of patients who undergo TTVI for TR. The investigators of this study examined the sex-related differences in the characteristics and outcomes of patients with TR who underwent TTVI. Data were collected between 2016 and 2021 from 702 patients (n women=386, mean age=78.1±7.93 years; n men=316, mean age=77.9±7.78) in this post hoc, multicenter analysis of prospectively collected data. All-cause mortality at 2 years was the primary outcome. Men were diagnosed with coronary artery disease more often than women (52.9% in men vs 35.5% in women; p=5.6 x 10-6), and TR etiology for men was mostly secondary ventricular (64.6% in men vs 50.0% in women; p=1.4 x 10-4). Women’s TR etiology was mostly secondary atrial (41.7% in women vs 24.4% in men; p=2.0 x 10-6). However, 2-year survival rates were similar between women and men (69.9% in women vs 63.7% in men; p=0.144). Independent predictors for 2-year mortality were identified using multivariate regression analysis: dyspnea (New York Heart Association functional class), tricuspid annulus plane systolic excursion (TAPSE) and mean pulmonary artery pressure (mPAP). On prognosis, there were differences between sexes in the significance of TAPSE and mPAP. Sex-specific thresholds were identified in right ventricular-pulmonary arterial (RV-PA) coupling expressed as TAPSE/mPAP (women with TAPSE/mPAP ratio <0.612 mm/mm Hg, 2-year mortality p<0.001 [3.43-fold increased HR for mortality at 2 years]; men with TAPSE/mPAP ratio <0.434 mm/mm Hg, 2-year mortality p=0.001 [2.05-fold increased HR for mortality at 2 years]). The investigators noted several limitations of this study. The study was limited to patients who underwent TTVI for severe TR, so the findings may not be applicable to patients with mild TR. There was also no control group in the study to be conservatively treated with optimized guideline-directed therapy. Overall, the pathophysiology of TR differs between men and women, but TTVI is equally efficient for treating both sexes when comparing procedural success and survival outcomes. Independent predictors for mortality after TTVI are dyspnea at initial TR diagnosis, pulmonary hypertension and right ventricular dysfunction. Sex-specific thresholds can improve all aspects of the diagnostic and treatment processes for TR. In an accompanying editorial, Georg Nickenig, MD, and Atsushi Sugiura, MD, PhD, of the University Hospital Bonn, Germany, discussed a brief history of sex differences in vascular disease and went on to evaluate the study by Fortmeier, Lachmann and colleagues. The editorialists noted there should be further studies to confirm the findings of the present study, and there could be many confounding factors at play. “Assuming the superior outcomes in women in the observational studies of TR, one could hypothesize that sex might affect the prognostic impact of TTVI. The potential confounders may be the underlying etiology of TR, RV function, and the extent of pulmonary artery (PA) remodeling,” they wrote. They also called for more research in the TAPSE/mPAP piece of the study, “Given the inherent selection bias for TTVI, it would be imperative to investigate the value and predictive power of TAPSE/mPAP in an all-comers population with TR.” Despite the need for follow-up investigation, the editorialists congratulated the investigators of this study for describing the relevance of RV-PA coupling in patients who underwent TTVI (TAPSE and mPAP). The editorialists concluded, “The current study provides vital momentum in improving our knowledge of differences in compositional TR between men and women.” Sources: Fortmeier V, Lachmann M, Körber MI, et al. Sex-Related Differences in Clinical Characteristics and Outcome Prediction Among Patients Undergoing Transcatheter Tricuspid Valve Intervention. JACC Cardiovasc Interv 2023 Apr 5 (Article in Press). Nickenig G, Sugiura A. Sex and TTVI: Equality in Efficacy. JACC Cardiovasc Interv 2023 Apr 5 (Article in Press). Image Credit: faustasyan – stock.adobe.com