Sex-Based Differences in Outcomes After Mitral Valve Surgery for Severe Ischemic Mitral Regurgitation

From the Cardiothoracic Surgical Trials Network

Gennaro Giustino, Jessica Overbey, Doris Taylor, Gorav Ailawadi, Katherine Kirkwood, Joseph DeRose, Marc A. Gillinov, François Dagenais, Mary Lou Mayer, Alan Moskowitz, Emilia Bagiella, Marissa Miller, Paul Grayburn, Peter K. Smith, Annetine Gelijns, Patrick O'Gara, Michael Acker, Anuradha Lala, Judy Hung

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

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)

Original languageEnglish (US)
Pages (from-to)481-490
Number of pages10
JournalJACC: Heart Failure
Volume7
Issue number6
DOIs
StatePublished - Jun 1 2019

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Mitral Valve Insufficiency
Mitral Valve
Sex Characteristics
Stroke Volume
Quality of Life
Confidence Intervals
Mortality
Ventricular Remodeling
Heart Valves
Hospitalization
Heart Failure
Stroke

Keywords

  • ischemic mitral regurgitation
  • mitral valve repair
  • mitral valve replacement
  • women

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Sex-Based Differences in Outcomes After Mitral Valve Surgery for Severe Ischemic Mitral Regurgitation : From the Cardiothoracic Surgical Trials Network. / Giustino, Gennaro; Overbey, Jessica; Taylor, Doris; Ailawadi, Gorav; Kirkwood, Katherine; DeRose, Joseph; Gillinov, Marc A.; Dagenais, François; Mayer, Mary Lou; Moskowitz, Alan; Bagiella, Emilia; Miller, Marissa; Grayburn, Paul; Smith, Peter K.; Gelijns, Annetine; O'Gara, Patrick; Acker, Michael; Lala, Anuradha; Hung, Judy.

In: JACC: Heart Failure, Vol. 7, No. 6, 01.06.2019, p. 481-490.

Research output: Contribution to journalArticle

Giustino, G, Overbey, J, Taylor, D, Ailawadi, G, Kirkwood, K, DeRose, J, Gillinov, MA, Dagenais, F, Mayer, ML, Moskowitz, A, Bagiella, E, Miller, M, Grayburn, P, Smith, PK, Gelijns, A, O'Gara, P, Acker, M, Lala, A & Hung, J 2019, 'Sex-Based Differences in Outcomes After Mitral Valve Surgery for Severe Ischemic Mitral Regurgitation: From the Cardiothoracic Surgical Trials Network', JACC: Heart Failure, vol. 7, no. 6, pp. 481-490. https://doi.org/10.1016/j.jchf.2019.03.001
Giustino, Gennaro ; Overbey, Jessica ; Taylor, Doris ; Ailawadi, Gorav ; Kirkwood, Katherine ; DeRose, Joseph ; Gillinov, Marc A. ; Dagenais, François ; Mayer, Mary Lou ; Moskowitz, Alan ; Bagiella, Emilia ; Miller, Marissa ; Grayburn, Paul ; Smith, Peter K. ; Gelijns, Annetine ; O'Gara, Patrick ; Acker, Michael ; Lala, Anuradha ; Hung, Judy. / Sex-Based Differences in Outcomes After Mitral Valve Surgery for Severe Ischemic Mitral Regurgitation : From the Cardiothoracic Surgical Trials Network. In: JACC: Heart Failure. 2019 ; Vol. 7, No. 6. pp. 481-490.
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abstract = "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)",
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T1 - Sex-Based Differences in Outcomes After Mitral Valve Surgery for Severe Ischemic Mitral Regurgitation

T2 - From the Cardiothoracic Surgical Trials Network

AU - Giustino, Gennaro

AU - Overbey, Jessica

AU - Taylor, Doris

AU - Ailawadi, Gorav

AU - Kirkwood, Katherine

AU - DeRose, Joseph

AU - Gillinov, Marc A.

AU - Dagenais, François

AU - Mayer, Mary Lou

AU - Moskowitz, Alan

AU - Bagiella, Emilia

AU - Miller, Marissa

AU - Grayburn, Paul

AU - Smith, Peter K.

AU - Gelijns, Annetine

AU - O'Gara, Patrick

AU - Acker, Michael

AU - Lala, Anuradha

AU - Hung, Judy

PY - 2019/6/1

Y1 - 2019/6/1

N2 - 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)

AB - 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)

KW - ischemic mitral regurgitation

KW - mitral valve repair

KW - mitral valve replacement

KW - women

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