What is the clinical evidence from this study?

Study design: Cohort. Population: Mitral valve prolapse undergoing mitral valve repair. Intervention: Female sex vs. Male sex. Primary outcome: Postoperative LV damage, defined as the presence of increased LV ESV index, impaired LVEF, or impaired LV GLS.

What does this research mean for the field?

In patients with mitral valve prolapse undergoing mitral valve repair, women are more prone to postoperative left ventricular dilatation and dysfunction than men, suggesting they are referred for surgery at a later stage of the disease. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

February 10, 2026Open Access

Sex Differences in Left Ventricular Size and Function before and after Mitral Valve Repair

Key Result

Following mitral valve repair, women are more prone to postoperative LV dilatation and dysfunction than men, with preoperative LV size discriminating outcomes in women (AUC 0.68).

Study Design

Type

Cohort

Multicenter

Yes

Structured PICO

Are there sex differences in left ventricular size and function before and after mitral valve repair in patients with mitral valve prolapse?

Population

Patients with mitral valve prolapse undergoing mitral valve repair at two centers between 2007 and 2024, excluding those with previous cardiac surgery, coronary artery disease, or nonsinus rhythm.

Exposure

Mitral valve repair (MVr)

Comparator

Sex comparison (men vs. women)

Outcome

Postoperative LV damage, defined as the presence of increased LV ESV index, impaired LVEF, or impaired LV GLSsurrogate

Women undergoing mitral valve repair for prolapse are more prone to postoperative LV dilatation and dysfunction compared to men, suggesting they may be referred for surgery at a later stage of disease and highlighting the need for sex-specific preoperative assessment.

Abstract

BACKGROUND: Among healthy subjects, women have smaller cardiac size than men even after indexing for body surface area (BSA), as well as higher left ventricular ejection fraction (LVEF) and left ventricular (LV) global longitudinal strain (GLS). Despite this, little is known about sex differences in LV remodeling in patients with mitral valve prolapse (MVP) undergoing mitral valve repair (MVr). The aim of this study was to assess pre- and post-MVr sex differences in LV size and function in patients with MVP. METHODS: Patients with MVP who underwent surgery between 2007 and 2024 at two heart valve centers were included. Those with previous cardiac surgery, coronary artery disease, other concomitant procedures than tricuspid valve repair, nonsinus rhythm at baseline, and with significant postsurgical mitral regurgitation (grade ≥ 2) were excluded. LV size was evaluated before and after surgery using both end-systolic diameter (ESD) and end-systolic volume (ESV), while LV function was assessed using LVEF and GLS. Thresholds for normal sex-specific LV size and function were based on current recommendations. The primary outcome was postoperative LV damage, defined as the presence of increased LV ESV index, impaired LVEF, or impaired LV GLS. The ability of preoperative measures of LV size to discriminate outcomes was assessed using receiver operating characteristic curve analyses. RESULTS: in women, with an area under the curve of 0.68. CONCLUSIONS: In patients with MVP undergoing MVr, women have higher BSA-adjusted LV size by ESD, whereas ESV remains larger in men. Only men demonstrate a significant reduction in LV ESV after MVr, whereas women are more prone to postoperative LV dilatation and dysfunction. The present findings suggest that women are undergoing surgery at a later stage of disease and support the need for sex-specific assessment of preoperative LV size when referring patients to mitral valve surgery.