Abstract 11277: Impact of Sex-Specific Echocardiographic Evaluation on Outcome of Patients With Organic Mitral Regurgitation

Abstract

Background: In patients with organic mitral regurgitation (OMR), women are less often diagnosed with severe disease and less referred to intervention. One of the potential explanations is the use of non-indexed and non-sex-specific guideline’s-based triggers for surgery. Aims: To compare predictors of the composite of cardio-vascular hospitalization and mortality under medical management in men and women with OMR. Methods: Between January and December 2014, 295 women and 269 men were diagnosed with at least mild isolated OMR. Event-free survival was compared with the use of adjusted Cox regression and inverse probability treatment weighting. Best thresholds predicting the composite endpoint at 3 years were derives from the Youden index on ROC curves analyses in both sexes separately. Results: Mean age was 68.5 ±14.1 years and the majority of patients (46%) had moderate OMR. Severity of OMR was similar between groups and inverse propensity weighting was used to balance clinical characteristics between sexes. Despite unadjusted and adjusted similar even-free survival under medical management, left atrium (LA) and left ventricle (LV) cavities were larger in men than in women (all p<0.001). Interestingly, even after indexation by BSA, thresholds associated with higher mortality were different between men and women (LV mass index: 118 g/m 2 in men, 88g/m 2 in women; LV ejection fraction: ≤ 55% in men, ≤ 65% in women; systolic pulmonary artery pressure: >42mmHg in men, >29mmHg in women), except for LA volume index (>32ml/m 2 in both sexes) . The use of sex-specific thresholds improves the prediction of events (p=0.002). Conclusion: Management of OMR should integrate sex-specific cut-points to trigger intervention, even for echo parameters indexed to BSA in order to harmonize outcomes between men and women with OMR.