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Sex Differences in Extensive Mitral Annular Calcification With Associated Mitral Valve Dysfunction
Timothy W Churchill1, Evin Yucel1, Samuel Bernard2
1Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
The American Journal of Cardiology
|March 7, 2023
Summary
Mitral annular calcification (MAC)-related mitral valve dysfunction affects women more, but men experience worse adjusted survival. The transmitral gradient
Area of Science:
- Cardiology
- Echocardiography
- Valvular Heart Disease
Background:
- Mitral annular calcification (MAC)-related mitral valve (MV) dysfunction is a growing clinical concern with significant morbidity and mortality.
- While MAC is more prevalent in women, data on gender-specific differences in its presentation and outcomes are limited.
Purpose of the Study:
- To investigate gender-based differences in the clinical and echocardiographic characteristics of patients with MAC-related MV dysfunction.
- To determine the prognostic significance of MAC-related MV dysfunction stratified by gender.
Main Methods:
- Retrospective analysis of 3,524 patients with extensive MAC and significant MV dysfunction (transmitral gradient ≥3 mm Hg).
- Patients were stratified into low, moderate, and high transmitral gradient groups.
- Adjusted Cox regression models were used to assess all-cause mortality.
Main Results:
- Women constituted 67% of the cohort, were older, and had fewer cardiovascular comorbidities than men.
- Women exhibited higher transmitral gradients, more concentric hypertrophy, and greater mitral regurgitation.
- Median survival was 3.4 years for women and 3.0 years for men, with worse adjusted survival observed in men.
Conclusions:
- Significant gender disparities exist in the phenotype of MAC-related MV dysfunction.
- Men with MAC-related MV dysfunction demonstrate worse adjusted survival compared to women.
- The prognostic impact of the transmitral gradient on mortality was comparable between genders.
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