Impact of gender on in-hospital and long-term outcomes after transcatheter aortic valve implantation: an analysis of the Spanish TAVI registry.

INTRODUCTION AND OBJECTIVES: Impact of gender on long-term outcomes after transcatheter aortic valve implantation (TAVI) remains uncertain. We aimed to investigate gender-specific differences in TAVI and its impact on outcomes. METHODS: This analysis used data from the prospective Spanish TAVI registry, which included consecutive TAVI patients treated in 46 Spanish centers from 2009 to 2021. The primary endpoint was all-cause mortality at 12 months. Secondary endpoints included in-hospital and 30-day mortality and TAVI-related complications. Adjusted logistic and Cox regression analyses were performed. RESULTS: The study included 12 253 consecutive TAVI patients with a mean age of 81.2 ± 6.4 years. Women (53.9%) were older, and had a higher STS-PROM score (7.0 ± 7.0 vs 6.2 ± 6.7; P < .001) than men. Overall, the TAVI-related complication rate was similar between women and men, with specific gender-related complications. While women more frequently developed in-hospital vascular complications (13.6% vs 9.8%; P < .001) and cardiac tamponade (1.5% vs 0.6%; P = .009), men showed a higher incidence of permanent pacemaker implantation (14.5% vs 17.4%; P = .009). There was no difference in all-cause mortality either in hospital (3.6% vs 3.6%, adjusted odds ratio [OR], 1.01; 95% confidence interval [95%CI], 0.83-1.23; P = .902), at 30 days (4.2% vs 4.2%, adjusted OR, 0.90; 95%CI, 0.65-1.25; P = .564) or at 1 year (11% vs 13%, adjusted HR, 0.94; [0.80-1.11]; P = .60). CONCLUSIONS: women treated with TAVI are older and have more comorbidities than men, leading to distinct complications between genders. Nevertheless, all-cause mortality in the short-term and at 1-year was similar between men and women.

Disfunción diastólica del paciente diabético estimada con ecocardiografía Doppler: relación con la ateromatosis y la disfunción microcirculatoria coronarias / Diastolic dysfunction in diabetic patients assessed with doppler echocardiography: relationship with coronary atherosclerotic burden and microcirculatory impairment

Introducción y objetivos. La diabetes mellitus (DM) se asocia al desarrollo tanto de alteraciones de la función diastólica ventricular izquierda (FDVI) como al de patología macrovascular y microvascular coronaria. El objetivo del estudio fue estudiar la posible relación entre ambas manifestaciones de la cardiopatía diabética. Métodos. En 13 pacientes con DM y cardiopatía isquémica se cuantificó la carga aterosclerótica (CA) mediante ecografía intracoronaria (IVUS) en la rama DA. A partir del registro digital de presión y velocidad de flujo intracoronarias, se calculó la reserva de velocidad de flujo coronario (RVFC), la conductancia coronaria, la presión de flujo cero (Pf0) y la resistencia coronaria. Se estudió la relación entre parámetros de FDVI (relaciones E/A y E/e) y las mediciones intracoronarias. Resultados. Se documentó una FEVI del 66% ± 7%, y una FDVI con E/A = 0,92 ± 0,38 y E/e = 9,9 ± 2,8. Se documentó una relación directamente proporcional (r = 0,62; p = 0,02) entre E/e y la resistencia coronaria (1,93 ± 0,74 mmHg/cm/s) y una relación inversamente proporcional (r = –0,64; p = 0,02) entre E/e y la conductancia coronaria (1,56 ± 0,5 cm/s/mmHg). No se encontró relación significativa entre los parámetros de FDVI y la RVFC (2,43 ± 0,56) o la Pf0 (40,41 ± 10,66 mmHg). El volumen de ateroma en los 20 mm proximales de la DA (179,34 ± 57,48 μl; área media de placa, 8,39 ± 2,2 mm2) no se relacionó con la FDVI. Conclusiones. En los pacientes con DM y aterosclerosis coronaria parece darse una relación entre la disfunción de la FDVI (estimada con el índice E/e) y la afección estructural de la microcirculación (AU)

Introduction and objectives. Diabetes mellitus (DM) is associated with the development of both impaired left ventricular diastolic function (LVDF) and pathological changes in the coronary macro- and microcirculation. The aim of this study was to investigate the relationship between these manifestations of diabetic heart disease. Methods. The severity of atherosclerosis in the left anterior descending coronary artery (LAD) was quantified using intravascular ultrasound (IVUS) in 13 patients with DM and ischemic heart disease. The coronary flow velocity reserve (CFVR), instantaneous hyperemic diastolic velocity pressure slope index (IHDVPS) zero-flow pressure were derived from digital intracoronary pressure and flow velocity measurements. The relationships between indices of LVDF (ie, E/A and E/e' ratios) and intracoronary measurements were assessed. Results. The left ventricular ejection fraction was 66% (7%), and the LVDF indices were: E/A=0.92 (0.38) and E/e'=9.90 (2.80). There was a direct proportional relationship (r=0.62; P=.02) between E/e' and coronary resistance (1.93 [0.74] mm Hg/s) and an inverse proportional relationship (r=−0.64; P=.02) between E/e' and IHDVPS (1.56 [0.50] cm/s/mm Hg). However, no significant relationship was found between either LVDF index and CFVR (2.43 [0.56]) or coronary zero-flow pressure (40.41 [10.66] mm Hg). The volume of atheroma in the proximal 20 mm of the LAD (179.34 [57.48] µL, with an average plaque area of 8.39 [2.20] mm2) was not related to either LVDF index. Conclusions. In patients with DM and coronary atherosclerosis, there appeared to be a relationship between LVDF impairment (assessed by the E/e' ratio) and structural changes in the microcirculation (AU)