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.