Sex-related hormonal variances and clinical outcomes in TAVR patients

Clin Res Cardiol. 2025 Nov;114(11):1527-1536. doi: 10.1007/s00392-025-02623-6. Epub 2025 Feb 24.

Abstract

Background: Sex-related differences play a pivotal role in disease manifestation and outcome in patients with cardiovascular disease, including aortic valve stenosis (AS). However, data regarding sex-related hormonal differences in AS patients undergoing transcatheter aortic valve replacement (TAVR) is lacking.

Objectives: We aimed to assess sex-related hormonal variances in patients with severe symptomatic AS and to evaluate the impact of these hormonal differences on the clinical outcomes after TAVR.

Methods: In a total of 361 TAVR patients, we assessed the hormonal status, including cortisol, parathormone (PTH), insulin-like growth factor 1 (IGF-1), dehydroepiandrosterone sulfate (DHEAs), estradiol, progesterone and testosterone prior to TAVR. We compared baseline characteristics and outcome data according to sex and hormonal parameters. The primary endpoint was 1-year all-cause mortality according to sex; secondary endpoints included the risk of 1-year all-cause mortality in conjunction with hormone levels, with pre-specified cut-off values.

Results: Rates of 1-year all-cause mortality were comparable between the sexes (p = 0.285). Cox regression analysis revealed significant associations between 1-year mortality and levels of cortisol (HR 2.30; p = 0.007), PTH (HR 2.09; p = 0.019), DHEA-S (HR 0.47; p = 0.016), and IGF-1 (HR 0.42; p = 0.004) in the overall cohort. Elevated cortisol levels (p = 0.011), decreased DHEA-S levels (p = 0.007), and lower IGF-1 levels (p = 0.017) were significantly associated with higher rates of 1-year all-cause mortality in males. Conversely, higher PTH levels were significantly associated with an increased risk of 1-year mortality in females (p = 0.012).

Conclusion: Sex-specific hormonal differences significantly impact the prognosis of severe AS patients undergoing TAVR. Elevated cortisol levels and decreased DHEA-S and IGF-1 levels in males, as well as higher levels of PTH in females, were associated with an increased mortality risk.

Keywords: Aortic stenosis; Clinical outcomes; Cortisol; DHEAs; Estradiol; Hormonal factors; IGF-1; Parathormone; Testosterone; Transcatheter Aortic Valve Replacement (TAVR).

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Valve Stenosis* / blood
  • Aortic Valve Stenosis* / mortality
  • Aortic Valve Stenosis* / surgery
  • Biomarkers / blood
  • Dehydroepiandrosterone Sulfate / blood
  • Female
  • Follow-Up Studies
  • Humans
  • Hydrocortisone / blood
  • Insulin-Like Growth Factor I / metabolism
  • Male
  • Parathyroid Hormone / blood
  • Retrospective Studies
  • Risk Factors
  • Severity of Illness Index
  • Sex Factors
  • Survival Rate / trends
  • Time Factors
  • Transcatheter Aortic Valve Replacement*
  • Treatment Outcome

Substances

  • Insulin-Like Growth Factor I
  • Biomarkers
  • Dehydroepiandrosterone Sulfate
  • Parathyroid Hormone
  • Hydrocortisone