Sex Differences in Right Ventricular Systolic Function and All-Cause Mortality in Tricuspid Regurgitation

Abstract

<b><i>Introduction:</i></b> Sex differences have been poorly studied in patients with right-sided heart valve disease. The principal aim of the current study was to explore the impact of sex differences on right ventricular (RV) hemodynamics and all-cause mortality in patients with moderate or severe tricuspid regurgitation (TR). <b><i>Methods:</i></b> This is a retrospective study of 209 patients with significant TR. All patients were clinically profiled at baseline and underwent a transthoracic echocardiogram. The cohort was followed up for clinical events for a median duration of 80 months (mean ± SD 69.4 ± 33.4 months). <b><i>Results:</i></b> There were 117 women with a mean (± SD) age of 72.6 ± 13 years and 92 men with a mean (± SD) age of 70.8 ± 15.8 years. There were no sex differences between the individual measures of RV systolic function (tricuspid annular plane systolic excursion [TAPSE], systolic pulmonary artery pressure, and RV S’), but overall RV systolic dysfunction (TAPSE &#x3c;16 mm and/or RV S’ &#x3c;10 cm/s) and left ventricular ejection fraction &#x3c;50% were more common in men. Mean (± SD) RV wall tension (RV WT) was 3,170 ± 1,220 mm Hg × mm in women and 3,817 ± 1,499 mm Hg × mm in men (<i>p</i> = 0.002)<i>.</i> There was no difference in all-cause mortality between women and men (Log-Rank <i>p</i> = 0.528). Age and increased RV WT were independent predictors of all-cause mortality both in women (hazard ratio [HR] 2.61) and men (HR 3.01). <b><i>Conclusions:</i></b> In this cohort of patients with significant TR, women more frequently had preserved RV systolic function than men. There was no sex-difference in all-cause mortality. An increased RV WT and higher age were independent predictors of all-cause mortality in both women and men.