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Canadian Journal of Cardiology

Sex Differences in Infective Endocarditis After Transcatheter Aortic Valve Replacement

      ABSTRACT

      Background

      Outcomes after transcatheter aortic valve replacement (TAVR) and infectious diseases may vary according to sex.

      Methods

      This multicenter study aimed to determine the sex differences in clinical characteristics, management, and outcomes of infective endocarditis (IE) after TAVR. A total of 579 patients (217 women, 37.5%) were included retrospectively from the Infectious Endocarditis after TAVR International Registry who had the diagnosis of definite IE following TAVR.

      Results

      Women were older (80±8 vs. 78±8 years, p=0.001) and exhibited a lower comorbidity burden. Clinical characteristics and microbiological profile were similar between men and women, but culture-negative IE was more frequent in women (9.9% vs. 4.3%, p=0.009). A high proportion of patients had a clinical indication for surgery (54.4% in both groups, p=0.99), but a surgical intervention was performed in a minority of patients (women: 15.2%, men: 20.3%, p=0.13). The mortality rate at index IE hospitalization was similar in both groups (women: 35.4%, men: 31.7%, p=0.373), but women exhibited a higher mortality rate at 2-year follow-up (63% vs. 52.1%, p=0.021). Female sex remained an independent risk factor for cumulative mortality in the multivariable analysis (HRadj: 1.28, 95% CI: 1.02-1.62, p=0.035). After adjustment for in-hospital events, surgery was not associated with better outcomes in women.

      Conclusions

      There were no significant sex-related differences in the clinical characteristics and management of IE after TAVR. However, female sex was associated with increased two-years mortality risk.

      Graphical abstract

      KEYWORDS

      ABBREVIATIONSLIST:

      IE (infective endocarditis), IQR (interquartile range), PVE (prosthetic valve endocarditis), TAVR (transcatheter aortic valve replacement), THV (trans-catheter heart valve)
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      REFERENCES

        • Vogel B.
        • Acevedo M.
        • Appelman Y.
        • Bairey Merz C.N.
        • Chieffo A.
        • Figtree G.A.
        • et al.
        The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030.
        Lancet. 2021 Jun 19; 397: 2385-2438
        • Mosca L.
        • Barrett-Connor E.
        • Wenger N.K.
        Sex/Gender Differences in Cardiovascular Disease Prevention What a Difference a Decade Makes.
        Circulation. 2011 Nov 8; 124: 2145-2154
      1. Gay L, Melenotte C, Lakbar I, Mezouar S, Devaux C, Raoult D, et al. Sexual Dimorphism and Gender in Infectious Diseases. Frontiers in Immunology [Internet]. 2021 [cited 2022 Jan 31];12. Available from: https://www.frontiersin.org/article/10.3389/fimmu.2021.698121

        • O’Connor S.A.
        • Morice M.-C.
        • Gilard M.
        • Leon M.B.
        • Webb J.G.
        • Dvir D.
        • et al.
        Revisiting Sex Equality With Transcatheter Aortic Valve Replacement Outcomes: A Collaborative, Patient-Level Meta-Analysis of 11,310 Patients.
        J Am Coll Cardiol. 2015 Jul 21; 66: 221-228
        • Chandrasekhar J.
        • Dangas G.
        • Yu J.
        • Vemulapalli S.
        • Suchindran S.
        • Vora A.N.
        • et al.
        Sex-Based Differences in Outcomes With Transcatheter Aortic Valve Therapy: TVT Registry From 2011 to 2014.
        Journal of the American College of Cardiology. 2016 Dec 27; 68: 2733-2744
        • Saad M.
        • Nairooz R.
        • Pothineni N.V.K.
        • Almomani A.
        • Kovelamudi S.
        • Sardar P.
        • et al.
        Long-Term Outcomes With Transcatheter Aortic Valve Replacement in Women Compared With Men: Evidence From a Meta-Analysis.
        JACC Cardiovasc Interv. 2018 Jan 8; 11: 24-35
        • Aksoy O.
        • Meyer L.T.
        • Cabell C.H.
        • Kourany W.M.
        • Pappas P.A.
        • Sexton D.J.
        Gender differences in infective endocarditis: Pre- and co-morbid conditions lead to different management and outcomes in female patients.
        Scandinavian Journal of Infectious Diseases. 2007 Jan 1; 39: 101-107
        • Sambola A.
        • Fernández-Hidalgo N.
        • Almirante B.
        • Roca I.
        • González-Alujas T.
        • Serra B.
        • et al.
        Sex Differences in Native-Valve Infective Endocarditis in a Single Tertiary-Care Hospital.
        American Journal of Cardiology. 2010 Jul 1; 106: 92-98
        • Sambola A.
        • Fernández-Hidalgo N.
        • Almirante B.
        • Roca I.
        • González-Alujas T.
        • Serra B.
        • et al.
        Sex differences in native-valve infective endocarditis in a single tertiary-care hospital.
        Am J Cardiol. 2010 Jul 1; 106: 92-98
        • Del Val D.
        • Linke A.
        • Abdel-Wahab M.
        • Latib A.
        • Ihlemann N.
        • Urena M.
        • et al.
        Long-Term Outcomes After Infective Endocarditis After Transcatheter Aortic Valve Replacement.
        Circulation. 2020 Oct 13; 142: 1497-1499
        • Regueiro A.
        • Linke A.
        • Latib A.
        • Ihlemann N.
        • Urena M.
        • Walther T.
        • et al.
        Association Between Transcatheter Aortic Valve Replacement and Subsequent Infective Endocarditis and In-Hospital Death.
        JAMA. 2016 Sep 13; 316: 1083-1092
        • Habib G.
        • Lancellotti P.
        • Antunes M.J.
        • Bongiorni M.G.
        • Casalta J.-P.
        • Del Zotti F.
        • et al.
        2015 ESC Guidelines for the management of infective endocarditisThe Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC)Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM).
        Eur Heart J. 2015 Nov 21; 36: 3075-3128
        • Kappetein A.P.
        • Head S.J.
        • Généreux P.
        • Piazza N.
        • van Mieghem N.M.
        • Blackstone E.H.
        • et al.
        Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document.
        J Am Coll Cardiol. 2012 Oct 9; 60: 1438-1454
        • Sevilla T.
        • Revilla A.
        • López J.
        • Vilacosta I.
        • Sarriá C.
        • Gómez I.
        • et al.
        Influence of Sex on Left-Sided Infective Endocarditis.
        Rev Esp Cardiol. 2010 Dec 1; 63: 1497-1500
        • Fournier P.-E.
        • Thuny F.
        • Richet H.
        • Lepidi H.
        • Casalta J.-P.
        • Arzouni J.-P.
        • et al.
        Comprehensive diagnostic strategy for blood culture-negative endocarditis: a prospective study of 819 new cases.
        Clin Infect Dis. 2010 Jul 15; 51: 131-140
        • Udell J.A.
        • Fonarow G.C.
        • Maddox T.M.
        • Cannon C.P.
        • Frank Peacock W.
        • Laskey W.K.
        • et al.
        Sustained sex-based treatment differences in acute coronary syndrome care: Insights from the American Heart Association Get With The Guidelines Coronary Artery Disease Registry.
        Clin Cardiol. 2018 Jun; 41: 758-768
        • Nanna M.G.
        • Wang T.Y.
        • Xiang Q.
        • Goldberg A.C.
        • Robinson J.G.
        • Roger V.L.
        • et al.
        Sex Differences in the Use of Statins in Community Practice.
        Circ Cardiovasc Qual Outcomes. 2019 Aug; 12e005562
        • Redfors B.
        • Angerås O.
        • Råmunddal T.
        • Petursson P.
        • Haraldsson I.
        • Dworeck C.
        • et al.
        Trends in Gender Differences in Cardiac Care and Outcome After Acute Myocardial Infarction in Western Sweden: A Report From the Swedish Web System for Enhancement of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART).
        J Am Heart Assoc. 2015 Jul 14; 4e001995
        • Crabtree T.D.
        • Pelletier S.J.
        • Gleason T.G.
        • Pruett T.L.
        • Sawyer R.G.
        Gender-Dependent Differences in Outcome After the Treatment of Infection in Hospitalized Patients.
        JAMA. 1999 Dec 8; 282: 2143-2148
        • Sousa C.
        • Nogueira P.J.
        • Pinto F.J.
        Gender Based Analysis of a Population Series of Patients Hospitalized with Infective Endocarditis in Portugal – How do Women and Men Compare?.
        Int J Cardiovasc Sci. 2021 Jul 12; 34: 347-355
        • Bansal A.
        • Cremer P.C.
        • Jaber W.A.
        • Rampersad P.
        • Menon V.
        Sex Differences in the Utilization and Outcomes of Cardiac Valve Replacement Surgery for Infective Endocarditis: Insights From the National Inpatient Sample.
        Journal of the American Heart Association. 2021 Oct 19; 10e020095