Why the study?
Current guidelines use standardised thresholds to define severe MR for intervention in primary mitral regurgitation, but sex-related differences in MR severity assessment and prognosis are unclear.
Do echocardiographic measures of mitral regurgitation severity and long-term mortality after primary mitral regurgitation intervention differ between females and males?
Cohort (n=420)
No
Do echocardiographic measures of mitral regurgitation severity and long-term mortality after primary mitral regurgitation intervention differ between females and males?
Females undergoing intervention for primary mitral regurgitation present with significantly lower absolute echocardiographic severity measures and face excess mortality at lower severity thresholds compared to males, indicating that applying uniform guideline cut-offs may inadvertently delay treatment for women.
Background Current guidelines advocate for intervention in primary mitral regurgitation (PMR) based on detection of severe MR using standardised thresholds. We sought to quantify sex-related differences in transthoracic echocardiography (TTE)-derived MR severity and long-term mortality after PMR intervention.Methods Consecutive patients undergoing PMR intervention with validated vena contracta (VC) measurements were included. Proximal isovelocity surface area radius (PISAr), effective regurgitant orifice area (EROA) and regurgitant volume (RVol) were also measured in a subset of patients. Using Cox models adjusted for PMR mortality risk factors, VC was modelled as a restricted cubic spline with an interaction term for sex. Sex-stratified receiver operating characteristic (ROC) curves were used to identify potential differences in risk calibration.Results Within 420 patients, females (n=168, 40%) displayed significantly lower absolute values of VC (median (interquartile range): 0.60 (0.55–0.80) vs 0.70 (0.60–0.80) cm, p=0.003), PISAr (0.85 (0.70–1.00) vs 1.10 (0.90–1.30) cm, n=96, p<0.001), EROA (0.35 (0.22–0.50) vs 0.60 (0.40–0.80) cm 2, n=58, p=0.018) and RVol (51 (43–83) vs 88 (67–108) mL, n=53, p=0.013) compared with males. In multivariable regression, sex-related differences in long-term all-cause mortality were moderated by VC (Pinteraction=0.013). In ROC curve analysis, VC had similar discriminatory ability in both sexes (p=0.768), although the optimum cut-off was lower in females (females: 0.67 cm vs males: 0.74 cm).Conclusions The present study demonstrates significant sex differences in TTE-measured MR severity and subsequent prognosis following intervention for PMR, which may merit sex-specific individualised thresholds.
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Long et al. (2026) conducted a cohort in Primary mitral regurgitation (PMR) (n=420). Female sex vs. Male sex was evaluated on Long-term all-cause mortality (p=0.013 for interaction).
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