Women had worse baseline and post-surgery RV function and higher moderate/severe tricuspid regurgitation (29.2% vs 12%, p=0.002), linked to higher adverse event risk.
Do sex-related differences impact cardiac remodeling and the combined endpoint of all-cause mortality and heart failure hospitalizations following mitral valve surgery for severe primary mitral regurgitation?
Women undergoing mitral valve surgery for severe primary mitral regurgitation exhibit persistently worse right ventricular function and remodeling at 1 year compared to men, which is strongly associated with increased mortality and heart failure hospitalizations.
Absolute Event Rate: 0% vs 0%
Abstract Background Reverse remodeling after mitral valve surgery is a critical determinant of long-term outcomes in patients with severe primary mitral regurgitation (PMR). While surgical intervention generally leads to improvements in cardiac structure and function, the extent and nature of these changes may differ between men and women. Understanding these variations is essential, as they may influence clinical decision-making, timing of surgery, and long-term prognosis. Purpose This study aimed to assess sex-related differences in cardiac remodeling following mitral valve surgery for PMR and their impact on clinical outcomes. Methods Consecutive patients with severe PMR who underwent surgery between 2014 and 2022 at a tertiary care center were included. Baseline and 1-year post-surgery echocardiograms were retrospectively analyzed and compared using a paired Student’s t-test. Logistic regression analysis was performed to assess the association between 1-year echocardiographic parameters and a combined endpoint of all-cause mortality and heart failure hospitalizations. Results Among 349 patients, 283 (122 women and 161 men) had complete echocardiographic follow-up data. At the time of surgery, women were older (71.3 ± 11 vs. 65.7 ± 12.8 years, p 0.001) and had a higher EuroSCORE II (4.2 ± 3.6 vs. 3.1 ± 4.3, p = 0.02) compared to men. Mitral valve repair was performed in 38.5% of patients, more frequently in men (46.6% vs. 27.9%, p 0.001), whereas concomitant tricuspid valve repair was more common in women (31.1% vs. 9.3%, p 0.001). At baseline, women exhibited worse biventricular function, particularly in left ventricular global longitudinal strain (LV GLS) and right ventricular-arterial (RV-AP) coupling. At one-year post-surgery, both sexes experienced a similar decline in left ventricular ejection fraction (LVEF) and LV GLS. Left atrial (LA) size significantly decreased in both groups, but LA reservoir strain also declined. Right ventricular (RV) function deteriorated post-surgery, with women displaying persistently higher pulmonary artery systolic pressure gradients and worse RV-AP coupling than men. Moderate or severe tricuspid regurgitation was more common in women at one year (29.2% vs. 12%, p = 0.002). One-year echocardiographic parameters significantly associated with the combined endpoint included LVEF (HR 0.97, 95% CI 0.94-0.99), significant tricuspid regurgitation (HR 2.5, 95% CI 1.4-4.7), and RV-AP coupling 0.35 (HR 3.2, 95% CI 1.7-6.0). Conclusions At one-year post-surgery, both men and women demonstrated significant reductions in LV and LA size, though this was accompanied by a decline in functional parameters. Women exhibited persistently worse RV function both at baseline and post-surgery, which correlated with a higher risk of adverse events. Strategies optimizing surgical timing and RV assessment may improve outcomes, particularly in female patients.Sex-based echocardiographic parameters. Outcomes after mitral intervention.
Mancebo et al. (Sat,) reported a other. Women had worse baseline and post-surgery RV function and higher moderate/severe tricuspid regurgitation (29.2% vs 12%, p=0.002), linked to higher adverse event risk.