Sex-related differences in cardiac damage associated with severe primary mitral regurgitation: impact on surgical outcomes

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Abstract Background and Aim Previous research has shown that women with primary mitral regurgitation (MPR) have worse surgical outcomes, compared with men. Our aim was to evaluate whether cardiac damage prior to intervention for severe MPR differs according to gender. Methods Retrospective analysis of a prospective cohort of patients with PMR who underwent mitral valve surgery in a tertiary care center from 2014 to 2022. Echocardiographic parameters measured prior to surgery as well as outcomes at 1-year follow-up (all-cause mortality and heart failure admissions) were analyzed, and potential differences by sex were evaluated. Results 349 patients were included. The mean age was 69 (12) years and 154 (44%) were female. Women were older and had a history of atrial fibrillation more frequently than men. Regardind morphological echocardiographic parameters, left ventricular (LV) dimensions were slightly larger in male patients, as expected, and there were no significant differences in left atrial (LA) volume index (Table). Significant differences were found in functional echocardiographic parameters: women had more impaired LV and LA strain, higher values of LA stiffness, and worse right ventricular-arterial coupling. In addition, concomitant significant tricuspid regurgitation was significantly more frequent in female patients. At one-year follow-up, the incidence of heart failure hospitalization was significantly higher in women (1% vs 7%; p=0.005) and there was a non-significant trend towards higher all-cause mortality (6.2 vs 11%; p=0.101). Conclusions In our cohort of patients with severe PMR who underwent surgery, women had worse biventricular function and more impaired LA function. At one-year follow-up, heart failure hospitalizations rates were significantly higher in female patients. Earlier indication of surgical timing in women with PMR, taking into account deformation parameters, could improve surgical outcomes in this population. Clinical and echocardiographic features