Page 41 - Advanced echocardiography in characterization and management of patients with secondary mitral regurgitation

Although, those studies consisted mainly of patients with secondary MR, a significant proportion of patients had other etiologies of MR and sub-analyses concerning only patients with secondary MR were not performed. In contrast, in the randomized CTNS trial, Giustino et al. 9 showed that among patients with secondary MR undergoing MV repair or replacement, women had a significantly higher risk for mortality when compared to men (27.1% vs. 17.4%, respectively; P= 0.03). The reasons for the worse outcome in women after MV surgery remain unclear. However, it is important to note that both men and women showed similar LV reverse remodeling at 2 years follow-up while women had smaller baseline LV volumes and larger effective regurgitant orifice areas when corrected for LV end-diastolic volume as compared to men, suggesting that women had more severe MR than men at baseline and, after correcting the volume overload with MV repair or replacement, their LVs benefited less. Data on more sensitive measures of LV systolic function such as LV GLS or tissue characterization with cardiac magnetic resonance were not available, but it can be speculated that women have stiffer, more fibrotic LVs than men.
In the present study, including ischemic and non-ischemic secondary MR, male gender was independently associated with worse outcome. However, the differences between men and women became evident 3 years after diagnosis of significant secondary MR (Figure 1) which could indicate progression of the underlying mechanism of secondary MR (progression of LV remodelling). Although no statistically significant difference was seen between men and women with ischemic heart failure (possibly due to the low number of women with ischemic heart failure in the present study), a trend of worse survival is seen in men with ischemic heart failure (Figure 2, Panel A). In men, the etiology of secondary MR was ischemic heart failure which is known to respond less well to heart failure therapies and may further progress over time, leading to worse outcome 24-26.
Study limitations
This is a single center retrospective study, which limits the generalizability of the results. In addition, this is a tertiary referral center where the patients are referred for specific treatments which may have introduced some selection bias. Measures for heart failure, such as NT-proBNP unfortunately were not systematically available and therefore could not be provided for the present study. Cardiac mortality was not systematically documented in our centre and due to the retrospective design of the study these data could not be acquired. However, to the best of our knowledge, this is the first and largest registry evaluating gender differences and long-term outcome in heart failure patients with secondary MR. The present study did not evaluate changes
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Ch 2