A. Altes , F. Levy , V. Hanet , D. De Azevedo , P. Krug , L. Iacuzio , M. Toledano , V. Silvestri , D. Vancraeynest , A. Pasquet , A. Vincentelli , A. Eker , S. Marechaux , B. Gerber
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Gerber","doi":"10.1016/j.acvdsp.2023.04.002","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p>The current recommended cut-off values for primary mitral regurgitation (MR) quantification (Effective Regurgitant Orifice Area [EROA], regurgitant volume [RegVol]) and left ventricular (LV) remodeling in MR (end-systolic diameter [ESD]) are not sex-specific.</p></div><div><h3>Method</h3><p>We retrospectively evaluated 470 patients (27% women, median age 63 years) with chronic significant primary MR due to prolapse who underwent echocardiography<span> (Echo) and cardiac magnetic resonance imaging (CMR) in 3 tertiary centers between 2005 and 2022.</span></p></div><div><h3>Results</h3><p><span>Women were older than men, had higher NYHA class, larger left atrial volume, higher pulmonary pressure, and more symptoms-triggered MV intervention (all </span><em>P</em> <!--><<!--> <!-->0.035). However, both MR EROA, Echo-RegVol and CMR-RegVol were lower in women than in men (all <em>P</em> <!--><<!--> <span>0.003), while CMR regurgitant fraction (RegFrac) values were similar (</span><em>P</em> <!-->=<!--> <!-->0.890). Abnormally increased CMR- (> upper limit bound of UK Biobank reference values) indexed LV end-diastolic (indLVEDV), end-systolic volume (indLVESV) were observed in 55%, 29% of patients, respectively, without sex difference (<em>P</em> <!-->=<!--> <!-->1, <em>P</em> <!-->=<!--> <!-->0.9). The optimal cut-off values of MR EROA, Echo-RegVol and CMR-RegVol associated with enlarged indLVEDV were lower in women (40 mm<sup>2</sup>, 60<!--> <!-->mL, 50<!--> <!-->mL) than in men (45 mm<sup>2</sup>,77<!--> <!-->mL, 62<!--> <!-->mL). LVESD ≥ 40<!--> <!-->mm showed in women and men high specificity [Sp] (91%, 79%) but poor sensitivity [Se] (40% 50%) to predict enlarged indLVESV, while the optimal threshold was slightly lower in women (35<!--> <!-->mm, Se<!--> <!-->=<!--> <!-->65%, Sp<!--> <!-->=<!--> <!-->71%) than in men (37<!--> <!-->mm, Se<!--> <!-->=<!--> <!-->65%, Sp<!--> <!-->=<!--> <!-->68%).</p></div><div><h3>Conclusion</h3><p>Despite clear hallmarks of more advanced valve disease, women with primary MR have lower mitral RegVol and lower ventricular volumes than men. Then, cut-off values of mitral RegVol, EROA and LV dimensions for predicting abnormal LV dilatation are lower in women than in men. Hence, guideline-based criteria for grading MR and timing of intervention could be sex-specific (<span>Fig. 1</span>).</p></div>","PeriodicalId":8140,"journal":{"name":"Archives of Cardiovascular Diseases Supplements","volume":"15 3","pages":"Page 243"},"PeriodicalIF":18.0000,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Impact of sex on severity assessment and cardiac remodeling in primary mitral regurgitation due to valve prolapse\",\"authors\":\"A. Altes , F. Levy , V. Hanet , D. De Azevedo , P. Krug , L. Iacuzio , M. Toledano , V. Silvestri , D. Vancraeynest , A. Pasquet , A. Vincentelli , A. Eker , S. Marechaux , B. Gerber\",\"doi\":\"10.1016/j.acvdsp.2023.04.002\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><p>The current recommended cut-off values for primary mitral regurgitation (MR) quantification (Effective Regurgitant Orifice Area [EROA], regurgitant volume [RegVol]) and left ventricular (LV) remodeling in MR (end-systolic diameter [ESD]) are not sex-specific.</p></div><div><h3>Method</h3><p>We retrospectively evaluated 470 patients (27% women, median age 63 years) with chronic significant primary MR due to prolapse who underwent echocardiography<span> (Echo) and cardiac magnetic resonance imaging (CMR) in 3 tertiary centers between 2005 and 2022.</span></p></div><div><h3>Results</h3><p><span>Women were older than men, had higher NYHA class, larger left atrial volume, higher pulmonary pressure, and more symptoms-triggered MV intervention (all </span><em>P</em> <!--><<!--> <!-->0.035). However, both MR EROA, Echo-RegVol and CMR-RegVol were lower in women than in men (all <em>P</em> <!--><<!--> <span>0.003), while CMR regurgitant fraction (RegFrac) values were similar (</span><em>P</em> <!-->=<!--> <!-->0.890). Abnormally increased CMR- (> upper limit bound of UK Biobank reference values) indexed LV end-diastolic (indLVEDV), end-systolic volume (indLVESV) were observed in 55%, 29% of patients, respectively, without sex difference (<em>P</em> <!-->=<!--> <!-->1, <em>P</em> <!-->=<!--> <!-->0.9). The optimal cut-off values of MR EROA, Echo-RegVol and CMR-RegVol associated with enlarged indLVEDV were lower in women (40 mm<sup>2</sup>, 60<!--> <!-->mL, 50<!--> <!-->mL) than in men (45 mm<sup>2</sup>,77<!--> <!-->mL, 62<!--> <!-->mL). LVESD ≥ 40<!--> <!-->mm showed in women and men high specificity [Sp] (91%, 79%) but poor sensitivity [Se] (40% 50%) to predict enlarged indLVESV, while the optimal threshold was slightly lower in women (35<!--> <!-->mm, Se<!--> <!-->=<!--> <!-->65%, Sp<!--> <!-->=<!--> <!-->71%) than in men (37<!--> <!-->mm, Se<!--> <!-->=<!--> <!-->65%, Sp<!--> <!-->=<!--> <!-->68%).</p></div><div><h3>Conclusion</h3><p>Despite clear hallmarks of more advanced valve disease, women with primary MR have lower mitral RegVol and lower ventricular volumes than men. Then, cut-off values of mitral RegVol, EROA and LV dimensions for predicting abnormal LV dilatation are lower in women than in men. 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引用次数: 0
摘要
目前推荐的初级二尖瓣反流(MR)定量(有效反流口面积[EROA]，反流容积[RegVol])和MR左心室重构(收缩末期直径[ESD])的临界值没有性别特异性。方法回顾性评估2005年至2022年间在3个三级中心接受超声心动图(Echo)和心脏磁共振成像(CMR)检查的470例因脱垂而患有慢性显著原发性MR的患者(27%为女性，中位年龄63岁)。结果女性比男性年龄大，NYHA分级高，左房容积大，肺动脉压高，症状引发的MV干预较多(P <0.035)。然而，女性的MR EROA、Echo-RegVol和CMR-RegVol均低于男性(P <0.003)，而CMR反流分数(RegFrac)值相似(P = 0.890)。CMR异常升高- (>在55%、29%的患者中分别观察到以UK Biobank参考值上限为指标的左室舒张末期容积(indLVEDV)、收缩末期容积(indLVESV)，无性别差异(P = 1, P = 0.9)。与indLVEDV增大相关的MR EROA、Echo-RegVol和CMR-RegVol的最佳临界值在女性中(40 mm2、60 mL、50 mL)低于男性(45 mm2、77 mL、62 mL)。LVESD≥40 mm在女性和男性中预测indLVESV增大的特异性[Sp]高(91%，79%)，敏感性[Se]低(40%，50%)，而女性的最佳阈值(35 mm, Se = 65%， Sp = 71%)略低于男性(37 mm, Se = 65%， Sp = 68%)。结论:尽管有更晚期瓣膜疾病的明确标志，但原发性MR女性的二尖瓣RegVol和心室容积低于男性。然后，二尖瓣RegVol、EROA和左室尺寸预测异常左室扩张的临界值在女性中低于男性。因此，基于指南的MR分级标准和干预时间可能是性别特异性的(图1)。
Impact of sex on severity assessment and cardiac remodeling in primary mitral regurgitation due to valve prolapse
Introduction
The current recommended cut-off values for primary mitral regurgitation (MR) quantification (Effective Regurgitant Orifice Area [EROA], regurgitant volume [RegVol]) and left ventricular (LV) remodeling in MR (end-systolic diameter [ESD]) are not sex-specific.
Method
We retrospectively evaluated 470 patients (27% women, median age 63 years) with chronic significant primary MR due to prolapse who underwent echocardiography (Echo) and cardiac magnetic resonance imaging (CMR) in 3 tertiary centers between 2005 and 2022.
Results
Women were older than men, had higher NYHA class, larger left atrial volume, higher pulmonary pressure, and more symptoms-triggered MV intervention (all P < 0.035). However, both MR EROA, Echo-RegVol and CMR-RegVol were lower in women than in men (all P < 0.003), while CMR regurgitant fraction (RegFrac) values were similar (P = 0.890). Abnormally increased CMR- (> upper limit bound of UK Biobank reference values) indexed LV end-diastolic (indLVEDV), end-systolic volume (indLVESV) were observed in 55%, 29% of patients, respectively, without sex difference (P = 1, P = 0.9). The optimal cut-off values of MR EROA, Echo-RegVol and CMR-RegVol associated with enlarged indLVEDV were lower in women (40 mm2, 60 mL, 50 mL) than in men (45 mm2,77 mL, 62 mL). LVESD ≥ 40 mm showed in women and men high specificity [Sp] (91%, 79%) but poor sensitivity [Se] (40% 50%) to predict enlarged indLVESV, while the optimal threshold was slightly lower in women (35 mm, Se = 65%, Sp = 71%) than in men (37 mm, Se = 65%, Sp = 68%).
Conclusion
Despite clear hallmarks of more advanced valve disease, women with primary MR have lower mitral RegVol and lower ventricular volumes than men. Then, cut-off values of mitral RegVol, EROA and LV dimensions for predicting abnormal LV dilatation are lower in women than in men. Hence, guideline-based criteria for grading MR and timing of intervention could be sex-specific (Fig. 1).
期刊介绍：
Archives of Cardiovascular Diseases Supplements is the official journal of the French Society of Cardiology. The journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles, editorials, and Images in cardiovascular medicine. The topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Additionally, Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.
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