Page 39 - Advanced echocardiography in characterization and management of patients with secondary mitral regurgitation

Considering patients receiving medical therapy only, women had lower mortality rates than men (5-year estimated rates 77% in women vs. 62% in men; P=0.001). On univariable analysis, age, male sex, chronic kidney disease, diabetes mellitus, ischemic heart failure, LVEF and LV GLS were significantly associated with all-cause mortality (Table 4). On multivariable analysis, after correcting for various clinical and echocardiographic parameters, male sex remained independently associated with all- cause mortality (HR 1.423; 95% CI, 1.109-1.826; P=0.006).
Table 4. Uni- and multivariable Cox regression analyses to identify associates of all-cause mortality.
Variable
Age
Male sex
BSA (m2)
eGFR (mL/min/1.73m2) Hypertension Diabetes mellitus Atrial fibrillation Ischemic aetiology NYHA classification ≥II Beta-blockers
Univariate
analysis
HR 95% CI
1.030 1.019-1.040 1.474 1.175-1.850 1.050 0.652-1.689 0.977 0.972-0.981 0.940 0.762-1.160 1.429 1.132-1.805 1.145 0.932-1.406 1.291 1.052-1.585 1.026 0.621-1.694 0.845 0.681-1.048 1.092 0.859-1.390 1.051 0.852-1.298 0.988 0.977-0.998 1.082 1.047-1.118
p-value HR
<0.001 1.020 0.001 1.423 0.842
<0.001 0.980 0.566
0.003 1.309 0.197
0.015 1.071 0.920
Multivariate analysis 95% CI 1.009-1.032 1.109-1.826
0.975-0.985 1.021-1.678 0.855-1.342
p-value
0.001 0.006
<0.001 0.034 0.550
CRT
MV intervention *
LVEF (%)
LV GLS (%)
BSA, body surface area; CI, confidence interval; CRT, cardiac resynchronization therapy; EDV, end-diastolic volume; eGFR, estimated glomerular filtration rate; HR, hazard ratio; LVEF, left ventricular ejection fraction; LV GLS, left ventricular global longitudinal strain; MV, mitral valve; NYHA, New York Heart Association.
* Combined surgical mitral valve repair, mitral valve replacement and percutaneous edge-to-edge mitral valve repair
Discussion
The present study shows that significant secondary MR is more frequent in men as compared to women. Ischemic etiology is the most frequent underlying mechanism in men whereas non-ischemic cardiomyopathy is more frequently observed in women. Men had a worse prognosis, compared to women.
0.125
0.471
0.642
0.025 0.999 <0.001 1.066
0.985-1.013 1.024-1.109
0.864 0.002
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