title: Comprehensive Imaging in Women With Organic Mitral Regurgitation: Implications for Clinical Outcome.
abstract: OBJECTIVE
  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.affiliation: 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.
authors.forename: Francesca
authors.initials: F
authors.lastname: Mantovani
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Marie-Annick
authors.initials: MA
authors.lastname: Clavel
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Hector I
authors.initials: HI
authors.lastname: Michelena
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Rakesh M
authors.initials: RM
authors.lastname: Suri
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Hartzell V
authors.initials: HV
authors.lastname: Schaff
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota. Electronic address: sarano.maurice@mayo.edu.
authors.forename: Maurice
authors.initials: M
authors.lastname: Enriquez-Sarano
mesh_terms: D000368:Aged; D016279:Atrial Function, Left; D049628:Body Size; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000209:etiology; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
keywords: cardiac remodeling; organic mitral regurgitation; outcomes; sex; surgery