Valvular & structural heart disease
Sex Differences in Clinical Presentation and Outcome of Degenerative Mitral Regurgitation Quantified: The MIDA-Q Registry
Main finding · Effective regurgitant orifice (ERO)Standardized mean difference 0.54- international registry
- prospectively quantified
- long-term follow-up
+2 more
- prospectively quantified
- long-term follow-up
Authors' conclusion
Women with DMR present with lower ERO and regurgitant volume than men and with considerable adaptive differences to increasing DMR severity versus men. Asymptomatic women are less referred to surgery than men of similar DMR severity, linked to smaller absolute left ventricular size. Severe DMR by similar quantitative thresholds causes similar excess mortality in men and women; moderate quantitative DMR shows a trend for higher excess mortality versus expected in women than men, requiring further confirmation. These data emphasize the importance of quantitative DMR and left ventricular remodeling assessment in men and women for appropriate clinical management.
Study context
- Population
- Men and women with greater than or equal to mild degenerative mitral regurgitation (DMR)3,274 men and 2331 women · men 3,274 · women 2,331
- Participants
- 2,331 vs 3,274
- Exposure
- Women versus men
- womenn = 2,331
- menn = 3,274reference
Main finding
Effective regurgitant orifice (ERO)
Standardized mean difference
0.54
P < 0.0001
By group
As reported in the abstract
Observational data: associations, not effects.
Further findings
Regurgitant volume · lower in women
standardized mean difference 0.52 · P < 0.0001
| Outcome | adjusted hazard ratio (CI) | P value | |
|---|---|---|---|
| Mitral valve surgery in asymptomatic patients · for similar ERO | 0.80 (0.69–0.94) | P = 0.008 | |
| 0.512Adjusted hazard ratio (log scale) |
| Outcome | women | men | Estimate | P value | |
|---|---|---|---|---|---|
| Excess mortality under medical management (severe versus mild ERO) | |||||
| adjusted hazard ratio | 1.67 [1.24-2.24]; P =0.0007 | 1.63 [1.27-2.09]; P <0.0001 | |||
| versus expected survival | 2.12 [1.51-2.98] | 2.27 [1.75-2.94] | |||
| Excess mortality with moderate ERO (20-39 mm 2) versus mild | hazard ratio 1.47 [1.19-1.77] | Not reported in the abstract | men: not reported in the abstract |
Mitral valve surgery in asymptomatic patients
- lower incidence in asymptomatic women versus men (adjusted hazard ratio, 0.80 [0.69-0.94]; P=0.008) for similar effective regurgitant orifice (ERO)
Excess mortality with moderate ERO (20-39 mm 2) versus mild
- In men, the corresponding hazard ratio did not reach statistical significance
Postoperative survival
- Postoperative survival was similar in men and women
Original publication
Summarised from the published abstract; every number is checked against it