Sex Differences in Morphology and Outcomes of Mitral Valve Prolapse

2 December 2008 | Volume 149 Issue 11 | Pages 787-794

Background: Mitral valve prolapse is more common in women than in men, but men more often have surgery for severe regurgitation.

Objective: To compare morphology and outcomes of mitral valve prolapse in men and women.

Design: Retrospective cohort study.

Setting: The Mayo Clinic, Rochester, Minnesota.

Patients: 4461 women and 3768 men who received a diagnosis of mitral valve prolapse by echocardiography from 1989 to 1998 (896 Olmsted County residents and 7333 referred patients).

Measurements: Mitral prolapse characteristics (localization, leaflet thickening or flail, regurgitation), ventricular and atrial characteristics, cardiac surgery, and mortality.

Results: Compared with men, women had less posterior prolapse (22% vs. 31%), less flail (2% vs. 8%), more leaflet thickening (32% vs. 28%), and less frequent severe regurgitation (10% vs. 23%) (P < 0.001 for all comparisons). Regardless of the severity of regurgitation, left ventricular and atrial diameters were smaller in women than in men but were larger in women after normalization to body surface area. Among patients with severe regurgitation, women were less likely than men to undergo cardiac valve surgery (52% vs. 60%; adjusted risk ratio, 0.79 [95% CI, 0.74 to 0.84]). At 15 years, women with no or mild mitral regurgitation had better odds of survival than men (87% vs. 77%; adjusted risk ratio, 0.82 [CI, 0.76 to 0.89]), but those with severe regurgitation had worse survival than men (60% vs. 68%; adjusted risk ratio, 1.13 [CI, 1.01 to 1.26]). The survival rate 10 years after surgery was similar in women and men (77% vs. 79%; P = 0.14). Observations in Olmsted County patients and referred patients were similar.

Limitation: Diagnoses were based on echocardiography, and clinical data at initial diagnosis, reason for index echocardiography, and cause of all deaths were lacking.

Conclusion: Morphology and severity of mitral valve prolapse differ according to sex. Among patients with severe regurgitation, women have higher mortality and lower surgery rates than men.

Editors' Notes Context Mitral valve prolapse is more common in women than in men, but men more frequently undergo surgery for severe regurgitation, possibly because of sex differences in disease morphology. Contribution Among 4461 women and 3768 men with an echocardiogram showing mitral valve prolapse at the Mayo Clinic, Rochester, Minnesota, from 1989 from 1998, women had less frequent severe regurgitation. However, women with severe regurgitation were less likely to have surgery and had worse survival than men. Survival did not differ between men and women who had surgery. Implication Although women generally have less severe mitral valve prolapse than men, those who do have severe disease have worse survival, possibly because they receive less aggressive therapy. —The Editors

 

Author and Article Information

From Hôpital La Timone, Marseille, France; Ospedale de l'Università di Bologna, Bologna, Italy; and the Mayo Clinic, Rochester, Minnesota.

Potential Financial Conflicts of Interest: Consultancies: B. Gersh (AstraZeneca, Boston Scientific, Novartis, Abbott Laboratories), M. Enriquez-Sarano (Edwards Life Science). Honoraria: F. Grigioni (Edwards Life Science), M. Enriquez-Sarano (Edwards Life Science). Stock ownership or options (other than mutual funds): B. Gersh (CV Therapeutics). Grants received: M. Enriquez-Sarano (Edwards Life Science, AstraZeneca, Pfizer).

Reproducible Research Statement: Study protocol, statistical code, and data set: Not available.

Requests for Single Reprints: Maurice Enriquez-Sarano, MD, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905; e-mail, sarano.maurice{at}mayo.edu.

Current Author Addresses: Dr. Avierinos: Service de Cardiologie, Hôpital La Timone, Marseille, France.

Dr. Inamo: Service de Cardiologie, Centre Hospitalo-Universitaire Fort-de-France, Fort-de-France, France.

Dr. Grigioni: Clinica de Cardiologia, Ospedale de l'Università di Bologna, Bologna, Italy.

Drs. Gersh, Shub, and Enriquez-Sarano: Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

Author Contributions: Conception and design: J.F. Avierinos, M. Enriquez-Sarano.

Analysis and interpretation of the data: J.F. Avierinos, F. Grigioni, C. Shub, M. Enriquez-Sarano.

Drafting of the article: J.F. Avierinos, F. Grigioni, C. Shub, M. Enriquez-Sarano.

Critical revision of the article for important intellectual content: J.F. Avierinos, J. Inamo, F. Grigioni, C. Shub, M. Enriquez-Sarano.

Final approval of the article: J. Inamo, C. Shub, M Enriquez-Sarano.

Provision of study materials or patients: M. Enriquez-Sarano.

Statistical expertise: J.F. Avierinos, M. Enriquez-Sarano.

Obtaining of funding: M. Enriquez-Sarano.

Administrative, technical, or logical support: B. Gersh.

Collection and assembly of data: J.F. Avierinos, J. Inamo, M. Enriquez-Sarano.

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