Author + information
- Gennaro Giustino, MD1,2,
- Jessica Overbey, MS2,
- Doris Taylor, PhD3,
- Gorav Ailawadi, MD4,
- Katherine Kirkwood, MS2,
- Joseph DeRose, MD5,
- Marc A. Gillinov, MD6,
- François Dagenais, MD7,
- Mary-Lou Mayer, RN8,
- Alan Moskowitz, MD2,
- Emilia Bagiella, PhD2,
- Marissa Miller, DVM, MPH9,
- Paul Grayburn, MD10,
- Peter K. Smith, MD11,
- Annetine Gelijns, PhD2,∗ (, )
- Patrick O'Gara, MD12,
- Michael Acker, MD8,
- Anuradha Lala, MD1,2 and
- Judy Hung, MD13
- 1The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
- 2Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
- 3Regenerative Medicine Research, Texas Heart Institute, Houston, TX
- 4Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, VA
- 5Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
- 6Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
- 7Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Canada
- 8Department of Surgery, Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA
- 9National Heart, Lung, and Blood Institute of the National Institutes of Health, Bethesda, MD
- 10Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
- 11Division of Cardiothoracic Surgery, Department of Surgery, Duke University, Durham, NC
- 12Division of Cardiology, Brigham and Women’s’ Hospital, Boston, MA
- 13Division of Cardiology, Massachusetts General Hospital, Boston, MA
- ↵∗Corresponding Author Annetine C. Gelijns, Ph.D. Department of Population Health Science and Policy Icahn School of Medicine at Mount Sinai One Gustave L Levy Place, Box 1077 New York, NY 10029 Phone: (1) 212 659 9567
Objectives To investigate sex-based differences in outcomes after mitral valve (MV) surgery for severe ischemic mitral regurgitation (SMR).
Background Whether differences in outcomes exist between men and women after surgery for SMR remains unknown.
Methods Patients enrolled in a randomized trial comparing MV replacement versus MV repair for SMR were included and followed for 2 years. Endpoints for this analysis included all-cause mortality, major adverse cardiovascular and cerebrovascular events (MACCE; defined as the composite of death, stroke, hospitalization for heart failure, worsening NYHA class or MV re-operation), quality of life (QOL), functional status, and percentage change in left ventricular (LV) end-systolic volume index (LVESVI) from baseline through 2 years.
Results Of 251 patients enrolled in the trial, 96 (38.2%) were women. Compared with men, women had smaller LV volumes and effective regurgitant orifice area (EROA) but greater EROA / LV end-diastolic volume ratio. At 2 years, women had higher rates of all-cause mortality (27.1% vs. 17.4%; adjusted hazard ratio [adjHR]: 1.85; 95% confidence interval [CI]: 1.05-3.26; p=0.03) and MACCE (49.0% vs. 38.1%; adjHR: 1.58; 95% CI: 1.06-2.37; p=0.02). Women also reported worse QOL and functional status at 2 years. There were no significant differences in the percentage change over 2 years in LVESVI between women and men (adjβ: -10.4; 95% CI: -23.4 to 2.6; p=0.12).
Conclusions Women with SMR display different echocardiographic features and experienced higher mortality and worse QOL after MV surgery compared with men. There were no significant differences in the degree of reverse LV remodeling between sexes.
Funding: The Severe Ischemic Mitral Regurgitation trial was supported by a cooperative agreement (U01 HL088942) funded by the National Heart Lung and Blood Institutes, the National Institutes of Neurological Disorders and Stroke of the National Institutes of Health (NIH), Bethesda, MD, and the Canadian Institutes of Health Research. The views expressed in this article are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institutes; National Institutes of Health; or the United States Department of Health and Human Services.
Clinical Trials.gov: NCT00807040
- Received December 4, 2018.
- Revision received February 17, 2019.
- Accepted March 5, 2019.
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