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The following is a summary of “Degenerative mitral regurgitation due to flail leaflet: sex-related differences in presentation, management, and outcomes,” published in the July 2024 issue of Cardiology by Avierinos et al.

Researchers conducted a retrospective study examining how clinical and echocardiographic traits in men and women referred for degenerative mitral regurgitation (DMR) from flail leaflets and its effect on management and outcomes. 

They compared females and males in the Mitral Regurgitation International Database (MIDA) registry on referral presentation, management, and outcomes (survival/heart failure (HF)), including medical treatment, post-operative care, and overall follow-up.

The results showed that at referral, females (n=650) were older and had more severe symptoms compared to males (n=1,660). Under conservative management, both genders had excess mortality, with females showing higher rates (standardized mortality ratio (SMR) 2.00 [1.67-2.38], P<0.001) vs. (SMR 1.45 [1.27-1.65], P<0.001). Females had a higher risk for mortality (aHR 1.29 [1.04-1.61], P=0.02), cardiovascular mortality (aHR 1.36 [1.02-1.81], P=0.007), and HF (aHR 1.36 [1.02-1.81], P=0.04). Surgical correction was less common in females (72% vs. 80%, P<0.001), but outcomes were similar after adjustment (P≥0.09). Throughout follow-up, females had worse outcomes (SMR 1.31 [1.16-1.47], P<0.001), while males restored normal life expectancy [SMR 0.92 [0.85-0.99], P=0.036).

Investigators concluded that females with severe DMR were referred later and experienced higher mortality and morbidity under conservative management and were also less likely to be offered and receive surgery promptly.

Source: academic.oup.com/eurheartj/article/45/26/2306/7674957