Abstract
BACKGROUND:
Degenerative mitral regurgitation (DMR) due to valve prolapse predominates in men, but sex-specific differences are poorly understood due to a lack of quantitative and sex-stratified studies.
METHODS:
The international MIDA-Q (Mitral Regurgitation International Database-Quantitative) registry enrolled 3274 men and 2331 women with greater than or equal to mild DMR prospectively quantified, comprehensively characterized, and long-term follow-up.
RESULTS:
Women were more symptomatic despite lower effective regurgitant orifice (ERO, 27±18 versus 38±22 mm
2
, standardized mean difference 0.54;
P
P
P
P
=0.008) for similar ERO, linked to smaller left ventricular diastolic absolute diameter (
P
P
=0.0007) and men (adjusted hazard ratio, 1.63 [1.27–2.09];
P
2
) was associated with significant excess mortality in women (1.47 [1.19–1.77] versus mild). In men, the corresponding hazard ratio did not reach statistical significance. Postoperative survival was similar in men and women.
CONCLUSIONS:
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.