Author + information
- Received January 14, 2016
- Revision received February 19, 2016
- Accepted February 25, 2016
- Published online April 1, 2016.
- Francesca Mantovani, MDa,b,c,
- Marie-Annick Clavel, DVM, PhDa,
- Hector I. Michelena, MDa,
- Rakesh M. Suri, MD, DPhila,
- Hartzell V. Schaff, MDa and
- Maurice Enriquez-Sarano, MDa,∗ ()
- aDivision of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota
- bDepartment of Cardiology, Policlinico Hospital, Modena and Reggio Emilia University, Modena, Italy
- cDepartment of Cardiology, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
- ↵∗Reprint requests and correspondence:
Dr. Maurice Enriquez-Sarano, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905.
Objectives The purpose of this study was to compare women and men with organic mitral regurgitation (MR) using pre- and post-operative comprehensive imaging and to analyze the effect on outcome.
Background Management of organic MR has no sex-specific guideline recommendation, and sex differences on the basis of comprehensive imaging and links to outcome remain largely unknown.
Methods Comprehensive imaging (MR cause, quantitation, ventricular and atrial measures, and post-operative reverse cardiac remodeling) was analyzed in 217 women and 447 men who underwent operations for organic MR from 1990 to 2000 with long-term follow-up analysis.
Results Pre-operatively, women and men had similar age and ejection fraction. In women, a smaller left ventricle (LV) more often labeled as normal size (23% vs. 13%), left atrium size, and regurgitant volume (all p < 0.01) contrasted with higher pulmonary pressure and more heart failure symptoms (41% vs. 19%), which more often triggered surgery (all p < 0.01). However, normalizing for body size, LV and left atrial diameters and regurgitant volume were at least as large in women versus men. Similar normalized MR severity was confirmed by similar post-operative reverse cardiac remodeling in women and men (all p > 0.06). During follow-up (10.4 ± 3.7 years) women had similar survival as men (p = 0.5) but experienced more heart failure (at 15 years: 36 ± 7% vs. 19 ± 3%; p = 0.03; adjusted hazard ratio 1.63 [95% confidence interval: 1.08 to 2.43]; p = 0.02) linked to more frequent pre-operative heart failure symptoms (p < 0.001).
Conclusions Women who undergo mitral surgery for organic MR receive similar repair for similar degenerative lesions defined by echocardiography and enjoy similar survival and reverse cardiac remodeling, but they incur excess post-operative heart failure linked to worse pre-operative presentation. Imaging that does not account for body size shows smaller absolute cardiac dimensions and regurgitant volumes, which tends to underestimate MR severity in women.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 14, 2016.
- Revision received February 19, 2016.
- Accepted February 25, 2016.
- American College of Cardiology Foundation