The Prognosis of Males and Females With Moderate or Severe Secondary Mitral Valve Regurgitation and Avenues for Improvement

Aims: To understand prognostic differences between sexes in (subtypes of) secondary mitral valve regurgitation (SMR) and to identify avenues for improvement.

Method and results: In this retrospective study, all consecutive patients diagnosed with moderate or severe SMR by echocardiographic assessment between January 1, 2014, and June 1, 2021 were included. Sex-specific analyses were performed using Cox proportional hazards analysis, adjusted for significant covariates. A total of 1245 patients with SMR (43% female) were included. Females more often had atrial SMR (233 (29%) females vs. 200 (21%) males, p < 0.01), males more often ischemic SMR (100 females (12%) vs. 245 males (25%), p < 0.01), and there were no significant differences between sexes in the proportion of non-ischemic SMR (199 (25%) females vs. 268 (28%) males, p = 0.99). The estimated 5-year survival was 70% (CI = 68%, 73%). Median follow-up was 4.3 years [2.7–6.2], 236 males and 128 females died during follow-up. Females had a better survival than males in a multivariable Cox model (HR = 0.67, p < 0.01).

Conclusion: Overall survival in patients with SMR was low with an estimated 5-year survival of 70%. Females had a better survival in patients with SMR than males. The lower survival in males with SMR might be due to a larger proportion of atrial SMR in females, fewer patients with ischemic SMR, and lower ejection fractions in males with non-ischemic SMR. The current focus on rapid heart failure medication optimization may improve the prognosis of the most vulnerable group; future studies can be directed to see whether this will be the case.