Abstract 12165: Gender-Based Differences in Left Ventricular Remodeling Due to Organic Mitral Regurgitation and Reverse-Remodeling Following Surgery: Implications for Timing of Intervention
Background: Current guidelines governing the performance of surgical correction of organic mitral regurgitation (OMR) are predicated upon absolute echocardiographic measures of left ventricular volume overload, irrespective of body size. The implications of gender-based differences have not been evaluated to date.
Aims: To compare absolute and indexed quantitative echocardiographic markers of left ventricular (LV) remodeling and OMR severity between gender, prior to and following mitral valve surgery.
Methods: We analyzed pre- and post-operative echocardiographic data of 655 patients (201 women, 31%) with pure, acquired, isolated OMR and preoperative quantitation of regurgitation severity undergoing surgical correction.
Results: Preoperatively, women vs. men had smaller body surface area (BSA 1.71±0.18 vs. 2.00±0.16 kg/m2, p=≤0.0001), LV end-diastolic diameter (LVEDD: 56±6 vs. 60±7 mm; p≤0.0001) and LV end-systolic diameter (LVESD: 34±5 vs. 37±6 mm; p≤0.0001), resulting in women more frequently being categorized as having a “normal” LV size (21 vs. 13%, p=0.0007). Women also had smaller regurgitant volumes (82±35 vs. 98±46 mL/beat, p≤0.0001). After normalizing to body size, BSA-indexed LVEDD (3.3±0.5 vs. 3.0±0.4 mm/m2, p≤0.0001), LVESD (2.0±0.3 vs. 1.9±0.3 mm/m2, p≤0.0001) and regurgitant volume (48.1±22.0 vs. 49.5±23.9 ml/m2, p=0.49) were at least as large in women as in men. Following surgery, women underwent the same degree of reverse LV remodeling as men: LVEDD (-7±7 vs. - 8±7 mm, p=0.14) establishing that in both genders a profound and similar reduction of large volume overload was achieved by surgery.
Conclusion: Women present for surgical intervention with smaller absolute LV dimensions more often categorized as “normal” and lower regurgitant volumes, potentially underestimating the physiologic severity and significance of LV volume overload. New criteria accounting for body size in the assessment of OMR severity are warranted and should be integrated into recommendations governing the performance of surgical correction.
- © 2013 by American Heart Association, Inc.