Sex-Based Differences in Outcomes After Mitral Valve Surgery for Severe Ischemic Mitral Regurgitation: From the Cardiothoracic Surgical Trials Network.

Aged Cause of Death Disease Progression Female Heart Failure Heart Valve Prosthesis Implantation Hospitalization / statistics & numerical data Humans Male Middle Aged Mitral Valve Annuloplasty Mitral Valve Insufficiency / etiology Mortality Myocardial Infarction / complications Myocardial Ischemia / complications Quality of Life Reoperation Severity of Illness Index Sex Factors Stroke / epidemiology Stroke Volume / physiology Treatment Outcome Ventricular Remodeling / physiology

ischemic mitral regurgitation mitral valve repair mitral valve replacement women

Journal

JACC. Heart failure

ISSN: 2213-1787

Titre abrégé: JACC Heart Fail

Pays: United States

ID NLM: 101598241

Informations de publication

Date de publication:
06 2019

Historique:

received: 04 12 2018

revised: 17 02 2019

accepted: 05 03 2019

entrez: 1 6 2019

pubmed: 31 5 2019

medline: 21 10 2020

Statut: ppublish

Résumé

This study investigated sex-based differences in outcomes after mitral valve (MV) surgery for severe ischemic mitral regurgitation (SIMR). Whether differences in outcomes exist between men and women after surgery for SIMR remains unknown. Patients enrolled in a randomized trial comparing MV replacement versus MV repair for SIMR were included and followed for 2 years. Endpoints for this analysis included all-cause mortality, major adverse cardiovascular and cerebrovascular events (MACCE) (defined as the composite of death, stroke, hospitalization for heart failure, worsening New York Heart Association functional class or MV re-operation), quality of life (QOL), functional status, and percentage of change in left ventricular end-systolic volume index (LVESVI) from baseline through 2 years. Of 251 patients enrolled in the trial, 96 (38.2%) were women. Compared with men, women had smaller LV volumes and effective regurgitant orifice areas (EROA) but greater EROA/left ventricular (LV) end-diastolic volume ratios. At 2 years, women had higher rates of all-cause mortality (27.1% vs. 17.4%, respectively; adjusted hazard ratio [adjHR]: 1.85; 95% confidence interval [CI]: 1.05 to 3.26; p = 0.03) and of MACCE (49.0% vs. 38.1%, respectively; adjHR: 1.58; 95% CI: 1.06 to 2.37; p = 0.02). Women also reported worse QOL and functional status at 2 years. There were no significant differences in the percentage of change over 2 years in LVESVI between women and men (adjβ: -10.4; 95% CI: -23.4 to 2.6; p = 0.12). Women with SIMR displayed different echocardiographic features and experienced higher mortality and worse QOL after MV surgery than men. There were no significant differences in the degree of reverse LV remodeling between sexes. (Comparing the Effectiveness of Repairing Versus Replacing the Heart's Mitral Valve in People With Severe Chronic Ischemic Mitral Regurgitation [Severe Ischemic Mitral Regurgitation]; NCT00807040).

Sections du résumé

OBJECTIVES

This study investigated sex-based differences in outcomes after mitral valve (MV) surgery for severe ischemic mitral regurgitation (SIMR).

BACKGROUND

Whether differences in outcomes exist between men and women after surgery for SIMR remains unknown.

METHODS

Patients enrolled in a randomized trial comparing MV replacement versus MV repair for SIMR were included and followed for 2 years. Endpoints for this analysis included all-cause mortality, major adverse cardiovascular and cerebrovascular events (MACCE) (defined as the composite of death, stroke, hospitalization for heart failure, worsening New York Heart Association functional class or MV re-operation), quality of life (QOL), functional status, and percentage of change in left ventricular end-systolic volume index (LVESVI) from baseline through 2 years.

RESULTS

Of 251 patients enrolled in the trial, 96 (38.2%) were women. Compared with men, women had smaller LV volumes and effective regurgitant orifice areas (EROA) but greater EROA/left ventricular (LV) end-diastolic volume ratios. At 2 years, women had higher rates of all-cause mortality (27.1% vs. 17.4%, respectively; adjusted hazard ratio [adjHR]: 1.85; 95% confidence interval [CI]: 1.05 to 3.26; p = 0.03) and of MACCE (49.0% vs. 38.1%, respectively; adjHR: 1.58; 95% CI: 1.06 to 2.37; p = 0.02). Women also reported worse QOL and functional status at 2 years. There were no significant differences in the percentage of change over 2 years in LVESVI between women and men (adjβ: -10.4; 95% CI: -23.4 to 2.6; p = 0.12).

CONCLUSIONS

Women with SIMR displayed different echocardiographic features and experienced higher mortality and worse QOL after MV surgery than men. There were no significant differences in the degree of reverse LV remodeling between sexes. (Comparing the Effectiveness of Repairing Versus Replacing the Heart's Mitral Valve in People With Severe Chronic Ischemic Mitral Regurgitation [Severe Ischemic Mitral Regurgitation]; NCT00807040).

Identifiants

DOI: 10.1016/j.jchf.2019.03.001 PMID: 31146872 PMC: PMC6676484

pubmed: 31146872

pii: S2213-1779(19)30151-9

doi: 10.1016/j.jchf.2019.03.001

pmc: PMC6676484

mid: NIHMS1528411

pii:

doi:

Banques de données

ClinicalTrials.gov

['NCT00807040']

Types de publication

Journal Article Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

Pagination

481-490

Subventions

Organisme : NHLBI NIH HHS

ID : U01 HL088942

Pays : United States

Organisme : CIHR

Pays : Canada

Commentaires et corrections

Type : CommentIn

Informations de copyright

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