In women undergoing surgery for severe mitral regurgitation, LVEF ≤55% was associated with a higher mortality risk compared with LVEF >60% (adjusted HR 3.48; 95% CI 1.84-6.58; P<0.001).
Cohort (n=1,686)
Yes
Does the association of left ventricular systolic function with mortality in patients with severe degenerative mitral regurgitation vary by sex?
Women with severe degenerative mitral regurgitation experience an earlier increase in mortality risk at higher LVEF levels (55-60%) compared to men, suggesting a need for sex-specific criteria for early surgical intervention.
Hazard Ratio: 3.48 (95% CI 1.84–6.58)
p-value: p=<.001
Importance: The association between left ventricular (LV) systolic dysfunction and adverse outcomes in patients with severe degenerative mitral regurgitation (MR) may vary by sex. Objective: To investigate the sex-specific association of LV systolic function with mortality in patients with severe degenerative MR. Design, Setting, and Participants: This retrospective cohort study included consecutive patients who underwent surgery for severe degenerative MR at 2 tertiary hospitals in South Korea from 2006 to 2020. Preoperative LV ejection fraction (LVEF) and LV global longitudinal strain (LV-GLS) were measured, with absolute LV-GLS values reported. Patients were stratified by LVEF (≤55%, >55% to ≤60%, and >60%) and LV-GLS (<19.9%, ≥19.9% to <23.4%, and ≥23.4%) tertiles. Mortality status was verified through December 2023, with a median (IQR) follow-up duration of 8.2 (5.3-12.2) years. Data analysis was conducted in March 2024. Exposures: Surgical MV repair or replacement. Main Outcomes and Measures: The primary outcome was all-cause mortality after MV surgery. Restricted cubic spline (RCS) curves visualized the association between LVEF, LV-GLS, and mortality for each sex. Results: Among 1686 patients, 1088 (64.5%) were men and 598 (35.5%) were women. Women were older than men (median IQR age, 62 51-70 vs 54 45-63 years) and had higher LVEF and LV-GLS than men did. During the follow-up, 220 (13.0%) deaths occurred (117 men 10.8%; 103 women 17.2%). In Kaplan-Meier curves, mortality in men increased in the lowest LVEF (≤55%) and LV-GLS (<19.9%) groups, whereas women exhibited an earlier increase in mortality at higher LVEF (55%-60%) and LV-GLS (19.9%-23.4%) levels. Multivariable Cox analyses showed a higher mortality risk associated with LVEF less than or equal to 55% (adjusted hazard ratio HR, 3.48; 95% CI, 1.84-6.58; P < .001) and 55% to 60% (adjusted HR, 2.21; 95% CI, 1.36-3.58; P = .001) compared with LVEF greater than 60% in women, but not in men (P for interaction by sex = .02). RCS curves showed an earlier increase in mortality risk at higher LVEF and LV-GLS levels in women. Similar trends were observed in asymptomatic patients. Conclusions and Relevance: In this cohort study of patients with severe degenerative MR, women had an earlier increase in mortality risk associated with LV systolic dysfunction, suggesting the need to consider sex-specific criteria for early surgery in asymptomatic patients.
Kwak et al. (Mon,) conducted a cohort in severe degenerative mitral regurgitation (n=1,686). Surgical MV repair or replacement was evaluated on all-cause mortality after MV surgery (HR 3.48, 95% CI 1.84-6.58, p=<.001). In women undergoing surgery for severe mitral regurgitation, LVEF ≤55% was associated with a higher mortality risk compared with LVEF >60% (adjusted HR 3.48; 95% CI 1.84-6.58; P<0.001).
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