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Comprehensive Imaging in Women With Organic Mitral Regurgitation: Implications for Clinical Outcome.
JACC Cardiovasc Imaging. 2016 Apr; 9(4):388-96.JC

Abstract

OBJECTIVES

The purpose of this study was to compare women and men with organic mitral regurgitation (MR) using pre- and post-operative comprehensive imaging and to analyze the effect on outcome.

BACKGROUND

Management of organic MR has no sex-specific guideline recommendation, and sex differences on the basis of comprehensive imaging and links to outcome remain largely unknown.

METHODS

Comprehensive imaging (MR cause, quantitation, ventricular and atrial measures, and post-operative reverse cardiac remodeling) was analyzed in 217 women and 447 men who underwent operations for organic MR from 1990 to 2000 with long-term follow-up analysis.

RESULTS

Pre-operatively, women and men had similar age and ejection fraction. In women, a smaller left ventricle (LV) more often labeled as normal size (23% vs. 13%), left atrium size, and regurgitant volume (all p < 0.01) contrasted with higher pulmonary pressure and more heart failure symptoms (41% vs. 19%), which more often triggered surgery (all p < 0.01). However, normalizing for body size, LV and left atrial diameters and regurgitant volume were at least as large in women versus men. Similar normalized MR severity was confirmed by similar post-operative reverse cardiac remodeling in women and men (all p > 0.06). During follow-up (10.4 ± 3.7 years) women had similar survival as men (p = 0.5) but experienced more heart failure (at 15 years: 36 ± 7% vs. 19 ± 3%; p = 0.03; adjusted hazard ratio 1.63 [95% confidence interval: 1.08 to 2.43]; p = 0.02) linked to more frequent pre-operative heart failure symptoms (p < 0.001).

CONCLUSIONS

Women who undergo mitral surgery for organic MR receive similar repair for similar degenerative lesions defined by echocardiography and enjoy similar survival and reverse cardiac remodeling, but they incur excess post-operative heart failure linked to worse pre-operative presentation. Imaging that does not account for body size shows smaller absolute cardiac dimensions and regurgitant volumes, which tends to underestimate MR severity in women.

Authors+Show Affiliations

Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota; Department of Cardiology, Policlinico Hospital, Modena and Reggio Emilia University, Modena, Italy; Department of Cardiology, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy.Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota.Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota.Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota.Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota.Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota. Electronic address: sarano.maurice@mayo.edu.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

27056158

Citation

Mantovani, Francesca, et al. "Comprehensive Imaging in Women With Organic Mitral Regurgitation: Implications for Clinical Outcome." JACC. Cardiovascular Imaging, vol. 9, no. 4, 2016, pp. 388-96.
Mantovani F, Clavel MA, Michelena HI, et al. Comprehensive Imaging in Women With Organic Mitral Regurgitation: Implications for Clinical Outcome. JACC Cardiovasc Imaging. 2016;9(4):388-96.
Mantovani, F., Clavel, M. A., Michelena, H. I., Suri, R. M., Schaff, H. V., & Enriquez-Sarano, M. (2016). Comprehensive Imaging in Women With Organic Mitral Regurgitation: Implications for Clinical Outcome. JACC. Cardiovascular Imaging, 9(4), 388-96. https://doi.org/10.1016/j.jcmg.2016.02.017
Mantovani F, et al. Comprehensive Imaging in Women With Organic Mitral Regurgitation: Implications for Clinical Outcome. JACC Cardiovasc Imaging. 2016;9(4):388-96. PubMed PMID: 27056158.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comprehensive Imaging in Women With Organic Mitral Regurgitation: Implications for Clinical Outcome. AU - Mantovani,Francesca, AU - Clavel,Marie-Annick, AU - Michelena,Hector I, AU - Suri,Rakesh M, AU - Schaff,Hartzell V, AU - Enriquez-Sarano,Maurice, PY - 2016/01/14/received PY - 2016/02/19/revised PY - 2016/02/25/accepted PY - 2016/4/9/entrez PY - 2016/4/9/pubmed PY - 2017/1/18/medline KW - cardiac remodeling KW - organic mitral regurgitation KW - outcomes KW - sex KW - surgery SP - 388 EP - 96 JF - JACC. Cardiovascular imaging JO - JACC Cardiovasc Imaging VL - 9 IS - 4 N2 - OBJECTIVES: The purpose of this study was to compare women and men with organic mitral regurgitation (MR) using pre- and post-operative comprehensive imaging and to analyze the effect on outcome. BACKGROUND: Management of organic MR has no sex-specific guideline recommendation, and sex differences on the basis of comprehensive imaging and links to outcome remain largely unknown. METHODS: Comprehensive imaging (MR cause, quantitation, ventricular and atrial measures, and post-operative reverse cardiac remodeling) was analyzed in 217 women and 447 men who underwent operations for organic MR from 1990 to 2000 with long-term follow-up analysis. RESULTS: Pre-operatively, women and men had similar age and ejection fraction. In women, a smaller left ventricle (LV) more often labeled as normal size (23% vs. 13%), left atrium size, and regurgitant volume (all p < 0.01) contrasted with higher pulmonary pressure and more heart failure symptoms (41% vs. 19%), which more often triggered surgery (all p < 0.01). However, normalizing for body size, LV and left atrial diameters and regurgitant volume were at least as large in women versus men. Similar normalized MR severity was confirmed by similar post-operative reverse cardiac remodeling in women and men (all p > 0.06). During follow-up (10.4 ± 3.7 years) women had similar survival as men (p = 0.5) but experienced more heart failure (at 15 years: 36 ± 7% vs. 19 ± 3%; p = 0.03; adjusted hazard ratio 1.63 [95% confidence interval: 1.08 to 2.43]; p = 0.02) linked to more frequent pre-operative heart failure symptoms (p < 0.001). CONCLUSIONS: Women who undergo mitral surgery for organic MR receive similar repair for similar degenerative lesions defined by echocardiography and enjoy similar survival and reverse cardiac remodeling, but they incur excess post-operative heart failure linked to worse pre-operative presentation. Imaging that does not account for body size shows smaller absolute cardiac dimensions and regurgitant volumes, which tends to underestimate MR severity in women. SN - 1876-7591 UR - https://www.unboundmedicine.com/medline/citation/27056158/Comprehensive_Imaging_in_Women_With_Organic_Mitral_Regurgitation:_Implications_for_Clinical_Outcome_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1936-878X(16)30007-9 DB - PRIME DP - Unbound Medicine ER -