Gender differences in the treatment of mitral valve prolapse

Mitral regurgitation (MR) may occur secondary to mitral value prolapsed (MVP), the latter having an estimated prevalence of 2.5% in the population. Severity of MR has been shown to be the main driver of outcome and also left ventricular and atrial changes, so surgical intervention remains the treatment of choice for MVP with severe MR. However, epidemiological studies have demonstrated that despite a female predominance for MVP, more men receive surgical intervention for this condition than compared to women.

In order to understand this apparent gender-specific difference Avierinos and colleagues studied morphological and outcome characteristics in 4,461 women and 3,768 men diagnosed with MVP. The authors found that when compared to men, women were younger (57 vs 62 years, p < 0.001), had more anterior and bileaflet prolapsed, more thickened leaflets, fewer flail leaflets and less regurgitation. Consequently, they concluded that women may present with a more benign form of MVP more frequently than men. However, although fewer in number compared to men (women, 446 (10%) vs men, 873 (23%)), women with severe MR underwent valve surgery less frequently and had greater long-term mortality than men (15 year survival, women 60% vs men 68%, p 0.049; risk of death, adjusted risk ratio among women = 1.13 [CI 1.01 to 1.26]), whereas survival after surgery was similar among both sexes (10 year post-operative survival, women 77% vs men 79%, p = 0.14).

Therefore, although the presentation of MVP is more often benign in women, it is important to appreciate that the severity of the condition may be difficult to assess. In the present study, left ventricular and atrial diameters were initially smaller in women than in men but became larger in women after normalisation to body surface area. Consequently, the authors conclude that assessment of cardiac enlargement among women remains problematic and that careful risk stratification, with appropriate adjustment for body size, is needed if both sexes are to receive the full benefit of valve surgery.

  • Avierinos J-F, Inamo j, Grigioni F et al. Sex Differences in Morphology and Outcomes of Mitral Valve Prolapse. Ann Intern Med 2008;149:787-794

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