Valvular & structural heart disease
Sex-Related Differences in Outcomes and Thresholds for Intervention in Primary Mitral Regurgitation: A Systematic Review and Meta-Analysis
Authors' conclusion
At the time of PMR intervention, women are older, have more symptoms, and worse long-term outcomes compared with men. Older female age alongside higher prevalence of ≥ moderate TR and TVr explained a significant proportion of this heterogeneity in sex-related all-cause mortality, whereas differences in left ventricular and left atrial parameters had no significant influence.
Study context
- Population
- Patients undergoing surgical or transcatheter intervention for primary mitral regurgitation (PMR)
- Participants
- 25,690 patients17 studies
- Comparison
- Women vs men
- Womenn = 9,632
- Outcome
- All-cause mortality
- Follow-up
- 15.7 years
Methodological detailsreconstructed time-to-event individual patient data, meta-regression
- Reconstructed time-to-event individual patient data
- Meta-regression
Pooled result
As reported in the abstract
15.7 years
Each group vs menHazard ratio (95% CI)
Women
1.15(1.07–1.24)
- Women
- survival deficit 5.8 months (95% CI 3.7–7.7)
Further pooled results
MACE (secondary endpoint), female sex
- Female sex: HR for MACE
- 1.37 (95% CI 1.11–1.70)
- Female sex: Δ restricted mean survival time, MACE
- 8.5 months (95% CI 2.4–14.5)
- MACE n = 2,775
All-cause mortality, sensitivity analysis restricted to surgical intervention studies
- HR
- 1.18 (95% CI 1.10–1.27)
Moderators of sex differences in mortality (meta-regression)
- Age
- P < 0.001
- ≥ moderate tricuspid regurgitation (TR)
- P = 0.03
- Concomitant tricuspid valve repair (TVr)
- P < 0.001
- LV or left atrial parameters: no significant moderation
- all P > 0.05
Original publication
Sex-Related Differences in Outcomes and Thresholds for Intervention in Primary Mitral Regurgitation: A Systematic Review and Meta-Analysis. JACC Cardiovasc Imaging. Published 10 July 2026. doi:10.
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