Sex-specific differences in right heart remodeling and patient outcomes in secondary tricuspid regurgitation
Bibliographic record
Abstract
Abstract Background Recent evidence shows sex differences in secondary tricuspid regurgitation (STR). However, guidelines do not provide sex-specific echocardiographic thresholds for assessing STR severity and identifying adverse remodeling of the right ventricle (RV) and tricuspid annulus (TA). Purpose We sought to evaluate whether cutoff values for regurgitation severity, as well as RV and TA remodeling associated with adverse outcomes differ between men and women with STR. Methods 554 consecutive patients (74±13 years, 51% women) with moderate and severe STR underwent conventional and advanced echocardiography. The primary study endpoint was the occurrence of all-cause mortality or hospitalization for heart failure (HHF). Results Women were older (p<0.001), had a higher prevalence of atrial fibrillation (p=0.008) and higher systolic blood pressure (p<0.001). In contrast, men were more likely to have coronary artery disease (p<0.001), stage IV-V chronic kidney disease (p=0.005), and significant mitral regurgitation (p<0.001). RV ejection fraction (RVEF) was higher in women (p<0.001). Furthermore, women also exhibited smaller RV, right atrium and TA than men. Importantly, atrial-STR was more prevalent in women (p<0.001). During a follow-up period of 19(8-27) months, 230 patients reached the composite endpoint. At the 2-year follow-up, event-free survival rates were comparable for both sexes (p=0.183), even after inverse-propensity weighting (p=0.342) (Figure 1). Risk-based sex-specific thresholds for STR severity differed between men and women, with lower cutoffs in women for the effective regurgitant orifice area (EROA) (0.36cm² vs. 0.43cm²), regurgitant volume (RegVol) (31mL vs. 35mL), and a higher regurgitant fraction (46% vs. 39%). Women also exhibited higher risk at lower thresholds for RV end-diastolic volume (81mL/m² vs. 96mL/m²), RV end-systolic volume (37mL/m² vs. 49mL/m²), and higher RVEF (49% vs. 41%). Similarly, sex-specific differences were observed in TA dimensions, with a 4-chamber TA diameter threshold of 19mm/m² for women versus 22mm/m² for men. Conclusions Although both sexes exhibit similar survival rates in STR, women face a higher risk at lower EROA and RegVol, as well as with smaller RV volumes, higher RVEF, and smaller TA dimensions. These findings highlight the importance of incorporating sex-specific thresholds into clinical decision-making when assessing STR severity and right heart remodeling to improve patient outcomes.Sex-Specific Differences in Right Heart
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".