Département de Cardiologie, Centre Hospitalier Universitaire Timone, Assistance Publique Hôpitaux de Marseille, Aix-Marseille Université, 264 rue Saint-Pierre, 13005 Marseille, France.
U1251 INSERM, Marseille Medical Genetics, Aix-Marseille Université, 27 Bd Jean Moulin, 13385 Marseille, France.
Eur Heart J. 2024 Jul 9;45(26):2306-2316. doi: 10.1093/eurheartj/ehae265.
Presentation, outcome, and management of females with degenerative mitral regurgitation (DMR) are undefined. We analysed sex-specific baseline clinical and echocardiographic characteristics at referral for DMR due to flail leaflets and subsequent management and outcomes.
In the Mitral Regurgitation International Database (MIDA) international registry, females were compared with males regarding presentation at referral, management, and outcome (survival/heart failure), under medical treatment, post-operatively, and encompassing all follow-up.
At referral, females (n = 650) vs. males (n = 1660) were older with more severe symptoms and higher MIDA score. Smaller cavity diameters belied higher cardiac dimension indexed to body surface area. Under conservative management, excess mortality vs. expected was observed in males [standardized mortality ratio (SMR) 1.45 (1.27-1.65), P < .001] but was higher in females [SMR 2.00 (1.67-2.38), P < .001]. Female sex was independently associated with mortality [adjusted hazard ratio (HR) 1.29 (1.04-1.61), P = .02], cardiovascular mortality [adjusted HR 1.58 (1.14-2.18), P = .007], and heart failure [adjusted HR 1.36 (1.02-1.81), P = .04] under medical management. Females vs. males were less offered surgical correction (72% vs. 80%, P < .001); however, surgical outcome, adjusted for more severe presentation in females, was similar (P ≥ .09). Ultimately, overall outcome throughout follow-up was worse in females who displayed persistent excess mortality vs. expected [SMR 1.31 (1.16-1.47), P < .001], whereas males enjoyed normal life expectancy restoration [SMR 0.92 (0.85-0.99), P = .036].
Females with severe DMR were referred to tertiary centers at a more advanced stage, incurred higher mortality and morbidity under conservative management, and were offered surgery less and later after referral. Ultimately, these sex-related differences yielded persistent excess mortality despite surgery in females with DMR, while males enjoyed restoration of life expectancy, warranting imperative re-evaluation of sex-specific DMR management.
二尖瓣脱垂（DMR）女性患者的临床表现、结局和处理仍不明确。我们分析了因连枷样瓣叶导致 DMR 转诊患者的性别特异性基线临床和超声心动图特征，以及随后的处理和结局。
在二尖瓣反流国际数据库（MIDA）国际注册中心，我们比较了女性患者与男性患者的转诊时临床表现、处理和结局（生存/心力衰竭），包括药物治疗、手术后以及所有随访。
在转诊时，女性（n=650）比男性（n=1660）年龄更大，症状更严重，MIDA 评分更高。较小的腔径反映了更高的心脏尺寸与体表面积之比。在保守治疗下，男性患者的死亡率高于预期[标准化死亡率比（SMR）1.45（1.27-1.65），P<.001]，而女性患者更高[SMR 2.00（1.67-2.38），P<.001]。女性性别与死亡率独立相关[校正后的危险比（HR）1.29（1.04-1.61），P=0.02]、心血管死亡率[校正 HR 1.58（1.14-2.18），P=0.007]和心力衰竭[校正 HR 1.36（1.02-1.81），P=0.04]，在药物治疗下。与男性相比，女性接受手术矫正的比例较低（72% vs. 80%，P<.001）；然而，考虑到女性患者病情更严重，手术结局相似（P≥.09）。最终，在整个随访期间，女性患者的总体结局较差，死亡率持续高于预期[SMR 1.31（1.16-1.47），P<.001]，而男性患者则恢复了正常的预期寿命[SMR 0.92（0.85-0.99），P=0.036]。
患有严重 DMR 的女性患者在更晚期被转诊至三级中心，在保守治疗下死亡率和发病率更高，转诊后接受手术的比例和时间均较低。最终，尽管女性 DMR 患者接受了手术，但这些与性别相关的差异仍导致持续的死亡率过高，而男性患者则恢复了预期寿命，这需要对 DMR 的性别特异性管理进行重要的重新评估。
