Key result
Female sex is linked to ~33% lower mortality in moderate or severe secondary mitral regurgitation.
Why the study?
To understand prognostic differences between sexes across subtypes of secondary mitral valve regurgitation and identify avenues for improvement.
Does female sex confer a survival advantage compared to male sex in patients with moderate or severe secondary mitral valve regurgitation?
Cohort (n=1,245)
Does female sex confer a survival advantage compared to male sex in patients with moderate or severe secondary mitral valve regurgitation?
Effect estimate: HR 0.67
p-value: p=<0.01
In patients with moderate or severe secondary mitral valve regurgitation, females have significantly better survival than males, potentially driven by differences in underlying SMR etiology.
Female sex associated with better survival in secondary mitral regurgitation; leaves open etiology-specific mechanisms and requires prospective validation.
AIMS: To understand prognostic differences between sexes in (subtypes of) secondary mitral valve regurgitation (SMR) and to identify avenues for improvement. METHOD AND RESULTS: In this retrospective study, all consecutive patients diagnosed with moderate or severe SMR by echocardiographic assessment between January 1, 2014, and June 1, 2021 were included. Sex-specific analyses were performed using Cox proportional hazards analysis, adjusted for significant covariates. A total of 1245 patients with SMR (43% female) were included. Females more often had atrial SMR (233 (29%) females vs. 200 (21%) males, p < 0.01), males more often ischemic SMR (100 females (12%) vs. 245 males (25%), p < 0.01), and there were no significant differences between sexes in the proportion of non-ischemic SMR (199 (25%) females vs. 268 (28%) males, p = 0.99). The estimated 5-year survival was 70% (CI = 68%, 73%). Median follow-up was 4.3 years [2.7-6.2], 236 males and 128 females died during follow-up. Females had a better survival than males in a multivariable Cox model (HR = 0.67, p < 0.01). CONCLUSION: Overall survival in patients with SMR was low with an estimated 5-year survival of 70%. Females had a better survival in patients with SMR than males. The lower survival in males with SMR might be due to a larger proportion of atrial SMR in females, fewer patients with ischemic SMR, and lower ejection fractions in males with non-ischemic SMR. The current focus on rapid heart failure medication optimization may improve the prognosis of the most vulnerable group; future studies can be directed to see whether this will be the case.
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Man et al. (2025) conducted a cohort in moderate or severe secondary mitral valve regurgitation (SMR) (n=1,245). Female sex vs. Male sex was evaluated on Survival (HR 0.67, p=<0.01). Female patients with moderate or severe secondary mitral valve regurgitation had significantly better survival compared to males (HR 0.67, p < 0.01).
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