Page 33 - Advanced echocardiography in characterization and management of patients with secondary mitral regurgitation

Introduction
Mitral regurgitation (MR) is one of the most common valvular diseases with a growing incidence and significant MR is associated with poor prognosis 1, 2. The frequency of significant MR in men and women is comparable 3. However, when evaluating the etiology of MR, significant differences are observed: secondary MR is more prevalent in men, whereas primary MR is more frequently present in women 3-5. Previous studies have shown differences between men and women undergoing surgical mitral valve repair for primary or secondary MR, with women having a higher mortality risks 4, 6, 7. In patients undergoing transcatheter edge-to-edge mitral valve repair with the MitraClip device, no sex differences were observed 8. However, these studies were mostly performed in patients with primary MR. A recent publication evaluating the sex differences in patients with secondary MR undergoing surgical mitral valve repair showed higher mortality risk in women as compared to men 9. The factors underlying these differences remain elusive, particularly among patients with secondary MR 10. Accordingly, the objective of this study is to investigate the sex distribution and long- term prognosis of patients with significant secondary MR.
Methods
Patient population
Patients with significant (moderate and severe) secondary MR were identified from 1999-2018 through the departmental echocardiographic database of the Leiden University Medical Center (Leiden, The Netherlands). Patients with previous mitral valve intervention were excluded. Baseline demographic, clinical and echocardiographic characteristics were prospectively collected through the departmental clinical database (EPD-Vision 11.8.4.0; Leiden University Medical Center, Leiden, The Netherlands) and were analyzed retrospectively. The institutional review board approved this retrospective study of clinically acquired data and waived the need for written patient informed consent.
Clinical variables included heart failure etiology (i.e. ischemic vs. non-ischemic), New York Heart Association (NYHA) functional class, comorbidities and medication use. Body surface area was calculated according to the Du Bois formula 11. Ischemic heart failure was defined based on coronary artery disease confirmed by coronary angiography, prior coronary revascularization with percutaneous coronary intervention and/or coronary artery bypass grafting (CABG). Mitral valve intervention included surgical mitral valve repair or replacement and transcatheter edge-to-edge mitral valve repair with the MitraClip device.
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