Sex Differences in Morphology and Outcomes of Mitral Valve Prolapse

  1. Jean-François Avierinos, MD;
  2. Jocelyn Inamo, MD;
  3. Francesco Grigioni, MD;
  4. Bernard Gersh, MD;
  5. Clarence Shub, MD; and
  6. Maurice Enriquez-Sarano, MD
  1. From Hôpital La Timone, Marseille, France; Ospedale de l'Università di Bologna, Bologna, Italy; and the Mayo Clinic, Rochester, Minnesota.

    Abstract

    Background: Mitral valve prolapse is more common in women than in men, but men more often have surgery for severe regurgitation.

    Objective: To compare morphology and outcomes of mitral valve prolapse in men and women.

    Design: Retrospective cohort study.

    Setting: The Mayo Clinic, Rochester, Minnesota.

    Patients: 4461 women and 3768 men who received a diagnosis of mitral valve prolapse by echocardiography from 1989 to 1998 (896 Olmsted County residents and 7333 referred patients).

    Measurements: Mitral prolapse characteristics (localization, leaflet thickening or flail, regurgitation), ventricular and atrial characteristics, cardiac surgery, and mortality.

    Results: Compared with men, women had less posterior prolapse (22% vs. 31%), less flail (2% vs. 8%), more leaflet thickening (32% vs. 28%), and less frequent severe regurgitation (10% vs. 23%) (P < 0.001 for all comparisons). Regardless of the severity of regurgitation, left ventricular and atrial diameters were smaller in women than in men but were larger in women after normalization to body surface area. Among patients with severe regurgitation, women were less likely than men to undergo cardiac valve surgery (52% vs. 60%; adjusted risk ratio, 0.79 [95% CI, 0.74 to 0.84]). At 15 years, women with no or mild mitral regurgitation had better odds of survival than men (87% vs. 77%; adjusted risk ratio, 0.82 [CI, 0.76 to 0.89]), but those with severe regurgitation had worse survival than men (60% vs. 68%; adjusted risk ratio, 1.13 [CI, 1.01 to 1.26]). The survival rate 10 years after surgery was similar in women and men (77% vs. 79%; P = 0.14). Observations in Olmsted County patients and referred patients were similar.

    Limitation: Diagnoses were based on echocardiography, and clinical data at initial diagnosis, reason for index echocardiography, and cause of all deaths were lacking.

    Conclusion: Morphology and severity of mitral valve prolapse differ according to sex. Among patients with severe regurgitation, women have higher mortality and lower surgery rates than men.

    Article and Author Information

    • Potential Financial Conflicts of Interest: Consultancies: B. Gersh (AstraZeneca, Boston Scientific, Novartis, Abbott Laboratories), M. Enriquez-Sarano (Edwards Life Science). Honoraria: F. Grigioni (Edwards Life Science), M. Enriquez-Sarano (Edwards Life Science). Stock ownership or options (other than mutual funds): B. Gersh (CV Therapeutics). Grants received: M. Enriquez-Sarano (Edwards Life Science, AstraZeneca, Pfizer).

    • Reproducible Research Statement: Study protocol, statistical code, and data set: Not available.

    • Requests for Single Reprints: Maurice Enriquez-Sarano, MD, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905; e-mail, sarano.maurice{at}mayo.edu.

    • Current Author Addresses: Dr. Avierinos: Service de Cardiologie, Hôpital La Timone, Marseille, France.

    • Dr. Inamo: Service de Cardiologie, Centre Hospitalo-Universitaire Fort-de-France, Fort-de-France, France.

    • Dr. Grigioni: Clinica de Cardiologia, Ospedale de l'Università di Bologna, Bologna, Italy.

    • Drs. Gersh, Shub, and Enriquez-Sarano: Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

    • Author Contributions: Conception and design: J.F. Avierinos, M. Enriquez-Sarano.

    • Analysis and interpretation of the data: J.F. Avierinos, F. Grigioni, C. Shub, M. Enriquez-Sarano.

    • Drafting of the article: J.F. Avierinos, F. Grigioni, C. Shub, M. Enriquez-Sarano.

    • Critical revision of the article for important intellectual content: J.F. Avierinos, J. Inamo, F. Grigioni, C. Shub, M. Enriquez-Sarano.

    • Final approval of the article: J. Inamo, C. Shub, M Enriquez-Sarano.

    • Provision of study materials or patients: M. Enriquez-Sarano.

    • Statistical expertise: J.F. Avierinos, M. Enriquez-Sarano.

    • Obtaining of funding: M. Enriquez-Sarano.

    • Administrative, technical, or logical support: B. Gersh.

    • Collection and assembly of data: J.F. Avierinos, J. Inamo, M. Enriquez-Sarano.

    Summary for Patients

    • Summaries for Patients:Differences in Mitral Valve Prolapse between Men and Women Ann Intern Med December 2, 2008 149:I-36; doi:10.1059/0003-4819-149-11-200812020-00001
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    1. Ann Intern Med December 2, 2008 vol. 149 no. 11 787-794
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