Sex Differences in Left Ventricular Size and Function before and after Mitral Valve Repair.

Area of Science:

• Cardiovascular Medicine
• Cardiac Surgery
• Cardiology

Background:

• Healthy women exhibit smaller cardiac size and higher left ventricular (LV) ejection fraction (EF) and global longitudinal strain (GLS) than men, even after body surface area (BSA) indexation.
• Sex differences in LV remodeling among patients with mitral valve prolapse (MVP) undergoing mitral valve repair (MVr) are not well understood.

Purpose of the Study:

• To investigate pre- and post-operative sex differences in LV size and function in patients with MVP undergoing MVr.

Main Methods:

• Retrospective analysis of 190 MVP patients (2007-2024) undergoing MVr, excluding those with prior surgery, coronary artery disease, or significant residual mitral regurgitation.
• LV size (end-systolic diameter/volume, ESV) and function (EF, GLS) were assessed pre- and post-MVr using sex-specific thresholds.
• Primary outcome: postoperative LV damage (enlarged LV end-systolic volume index [ESVi], impaired EF, or impaired GLS).

Main Results:

• Preoperatively, men had larger LV end-systolic volumes (ESV), while women had higher BSA-adjusted LV end-systolic diameter (ESD).
• Postoperatively, only men showed a significant reduction in LV ESV. Women were 6.3 times more likely to have LV dilation and 3.3 times more likely to have impaired LV GLS.
• LV EF remained similar between sexes, but preoperative LV GLS was higher in women. Optimal LV ESD/BSA cutoffs for predicting postoperative damage differed by sex.

Conclusions:

• Women with MVP undergoing MVr experience higher rates of postoperative LV dilation and dysfunction compared to men.
• Findings suggest women may be operated at a later disease stage, highlighting the need for sex-specific preoperative LV size assessment.
• Tailored surgical referral criteria based on sex-specific LV parameters are recommended for optimizing outcomes in MVP patients.