Sex differences in pre- and post-surgical left ventricular remodelling and outcomes in primary mitral regurgitation

Abstract

Aims: Studies suggest that females have worse post-surgical left ventricular (LV) reverse remodelling and clinical outcomes than males in primary mitral regurgitation (MR). These studies were retrospective, used linear dimensions of the LV, and did not account for MR severity. This study is to determine if there are sex differences with respect to pre- and post-surgical LV remodelling and clinical outcomes.

Methods and results: There were 143 prospectively enrolled patients (60 ± 12 years, males 70%) with primary MR who underwent pre- and post-surgical CMR evaluation. Clinical outcomes were ascertained by patient interview and chart review. Adverse outcomes were a composite of heart failure hospitalisations, need for reoperation, and death. MR volume (MRV) and MR fraction (MRF) were independent predictors of pre-surgical LV end-diastolic volume (LVEDV) and post-surgical change in LVEDV and sex was not an independent predictor. For each 1 mL increase in MRV there was an increase in pre-surgical LVEDV of 0.93 mL for males and 1.0 mL for females and a post-surgical decrease in LVEDV of 1.1 mL for males and 1.0 mL for females. Over a mean follow-up period of 3.3 ± 2.6 years there were 10 (7%) patients with adverse events and no significant difference in the event rate between males and females (6% vs. 11%, P = 0.5).

Conclusion: In primary MR there were no sex differences in the degree of pre-surgical LV dilatation or post-surgical LV reverse remodelling. There were no sex differences in adverse clinical events. These findings highlight that males and females benefit similarly from mitral valve surgery and females should be referred for mitral valve surgery when appropriate.(Clinical Trials: NCT04038879, NCT03012178, and NCT04051411).

Keywords: mitral regurgitation; mitral valve surgery; sex.