Sex differences in morphology and outcomes of mitral valve prolapse

Jean François Avierinos, Jocelyn Inamo, Francesco Grigioni, Bernard Gersh, Clarence Shub, Maurice E Sarano

Research output: Contribution to journalArticle

57 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)787-794
Number of pages8
JournalAnnals of Internal Medicine
Volume149
Issue number11
StatePublished - Dec 2 2008

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Mitral Valve Prolapse
Sex Characteristics
Echocardiography
Prolapse
Odds Ratio
Thoracic Surgery
Survival
Mortality
Body Surface Area
Heart Valves
Mitral Valve Insufficiency
Cause of Death
Cohort Studies
Survival Rate
Retrospective Studies

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Avierinos, J. F., Inamo, J., Grigioni, F., Gersh, B., Shub, C., & Sarano, M. E. (2008). Sex differences in morphology and outcomes of mitral valve prolapse. Annals of Internal Medicine, 149(11), 787-794.

Sex differences in morphology and outcomes of mitral valve prolapse. / Avierinos, Jean François; Inamo, Jocelyn; Grigioni, Francesco; Gersh, Bernard; Shub, Clarence; Sarano, Maurice E.

In: Annals of Internal Medicine, Vol. 149, No. 11, 02.12.2008, p. 787-794.

Research output: Contribution to journalArticle

Avierinos, JF, Inamo, J, Grigioni, F, Gersh, B, Shub, C & Sarano, ME 2008, 'Sex differences in morphology and outcomes of mitral valve prolapse', Annals of Internal Medicine, vol. 149, no. 11, pp. 787-794.
Avierinos JF, Inamo J, Grigioni F, Gersh B, Shub C, Sarano ME. Sex differences in morphology and outcomes of mitral valve prolapse. Annals of Internal Medicine. 2008 Dec 2;149(11):787-794.
Avierinos, Jean François ; Inamo, Jocelyn ; Grigioni, Francesco ; Gersh, Bernard ; Shub, Clarence ; Sarano, Maurice E. / Sex differences in morphology and outcomes of mitral valve prolapse. In: Annals of Internal Medicine. 2008 ; Vol. 149, No. 11. pp. 787-794.
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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.",
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AU - Avierinos, Jean François

AU - Inamo, Jocelyn

AU - Grigioni, Francesco

AU - Gersh, Bernard

AU - Shub, Clarence

AU - Sarano, Maurice E

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N2 - 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.

AB - 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.

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