Sex Differences in Epidemiology, Morphology, Mechanisms, and Treatment of Mitral Valve Regurgitation

Tersalvi, Gregorio; Gaiero, Lorenzo; Capriolo, Michele; Cristoforetti, Yvonne; Salizzoni, Stefano; Senatore, Gaetano; Pedrazzini, Giovanni; Biasco, Luigi

doi:10.3390/medicina59061017

Cited by 9 publications

(11 citation statements)

References 64 publications

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“…Evidence derived from transcatheter edge‐to‐edge mitral valve repair (TEER) mirrors surgical experiences, showing that women are underrepresented in both trials and real‐life registries, are often referred to TEER at an older age, and present with a worse functional capacity and with a higher perceived frailty that justifies a percutaneous approach. 4 , 10 Outcomes after TEER at short‐ and midterm follow‐up seem to be comparable between sexes. Nonetheless, the reported persistence of limiting symptoms even after adequate management of MR in women represents an unmet need for treatment.…”

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confidence: 84%

“…Women are significantly underreferred and show higher mortality after surgery, and a lower clinical efficacy following percutaneous treatments has been also suggested. 3 , 4 , 5 …”

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confidence: 99%

“…Nonetheless, the reported persistence of limiting symptoms even after adequate management of MR in women represents an unmet need for treatment. 4 …”

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confidence: 99%

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Technical and Clinical Outcomes After Transcatheter Edge‐to‐Edge Repair of Mitral Regurgitation in Male and Female Patients: Is Equality Achieved?

Biasco,

Tersalvi,

Klersy

et al. 2024

JAHA

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Background Currently, no clear impact of sex on short‐ and long‐term survival following transcatheter edge‐to‐edge mitral valve repair (TEER) is evident, although no data are available on postprocedural life expectancy. Our aim was to assess sex‐specific differences in outcomes of patients with mitral regurgitation (MR) treated by TEER. Methods and Results Short‐term and 5‐year outcomes in men and women undergoing TEER between 2011 and 2018 who were included in the large, multicenter, real‐world MitraSwiss registry were analyzed. Outcomes were compared stratified by sex and according to MR cause (primary versus secondary). The impact of TEER on postprocedural life expectancy was estimated by relative survival analysis. Among 1142 patients aged 60 to 89 years, 39.8% were women. They were older, with fewer cardiovascular risk factors and lower functional capacity compared with men. Thirty‐day mortality was higher in men than in women (3.3% versus 1.1%; odds ratio, 3.16 [95% CI, 1.16–10.7]; P =0.020). Five‐year survival was comparable in both sexes (adjusted hazard ratio for 5‐year mortality in men, 1.14 [95% CI, 0.90–1.44], P =0.275). Both men and women with either primary or secondary MR showed similar clinical efficacy over time. TEER provided high relative survival estimates among all groups, and fully restored predicted life expectancy in women with primary MR (5‐year relative survival estimate, 97.4% [95% CI, 85.5–107.0]). Conclusions TEER is not associated with increased short‐term mortality in women, whereas 5‐year outcomes are comparable between sexes. Moreover, TEER completely restored normal life expectancy in women with primary MR. A residual excess mortality persists in secondary MR, independently of sex.

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confidence: 84%

“…Women are significantly underreferred and show higher mortality after surgery, and a lower clinical efficacy following percutaneous treatments has been also suggested. 3 , 4 , 5 …”

mentioning

confidence: 99%

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Technical and Clinical Outcomes After Transcatheter Edge‐to‐Edge Repair of Mitral Regurgitation in Male and Female Patients: Is Equality Achieved?

Biasco,

Tersalvi,

Klersy

et al. 2024

JAHA

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“…Therefore, it is quite important to dissect the sex-biased molecules in physiology and disease and systematically analyze them. Previous studies have found many variations in disease development and treatment responses between men and women, underscoring the need to identify and analyze these differences to optimize modern medical strategies [ 2 , 3 ]. MicroRNAs (miRNAs) are one class of short noncoding RNA molecules that do not encode proteins but perform crucial functions in regulating various cellular activities and physiological processes at the post-transcriptional level, including cell growth, differentiation, apoptosis, immune and inflammation response, development, and metabolism [ 4 ].…”

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confidence: 99%

Identification and Analysis of Sex-Biased MicroRNAs in Human Diseases

Zhong,

Cui,

Cui

2023

Genes

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It is well known that significant differences exist between males and females in both physiology and disease. Thus, it is important to identify and analyze sex-biased miRNAs. However, previous studies investigating sex differences in miRNA expression have predominantly focused on healthy individuals or restricted their analysis to a single disease. Therefore, it is necessary to comprehensively identify and analyze the sex-biased miRNAs in diseases. For this purpose, in this study, we first identified the miRNAs showing sex-biased expression between males and females in diseases based on a number of miRNA expression datasets. Then, we performed a bioinformatics analysis for these sex-biased miRNAs. Notably, our findings revealed that women exhibit a greater number of conserved miRNAs that are highly expressed compared to men, and these miRNAs are implicated in a broader spectrum of diseases. Additionally, we explored the enriched transcription factors, functions, and diseases associated with these sex-biased miRNAs using the miRNA set enrichment analysis tool TAM 2.0. The insights gained from this study could carry implications for endeavors such as precision medicine and possibly pave the way for more targeted and tailored approaches to disease management.

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“…In addition to the outlined differences in the epidemiology of MR, however, there appear to be even more profound sex-specific disparities in the subsequent management. Thus, women have been shown to be greatly underrepresented in clinical trials of both surgical and percutaneous MR therapies, to have lower access to surgery, and to be referred for intervention at a later stage of the disease [2,7]. While females undergoing MV surgery have higher perioperative mortality and lower long-term survival compared with male patients [8][9][10], it is unclear whether this also applies to the growing cohort of high-risk patients treated percutaneously.…”

Section: Introductionmentioning

confidence: 99%

Sex-Specific Disparities in Outcomes of Transcatheter Edge-to-Edge Repair for Mitral Regurgitation: A Multicenter “Real-World” Analysis

Ausbuettel,

Barth,

Chatzis

et al. 2023

JCM

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Background: mitral regurgitation (mr) is the most common valvular heart disease (vhd) in the elderly and tends to be more prevalent in women. while relevant sex differences in outcomes are evident in surgically treated collectives, there are very limited and conflicting sex-specific data for the growing cohort of patients undergoing transcatheter edge-to-edge repair (teer). Objective: to investigate whether sex impacts procedural safety and efficacy, and in-hospital- and long-term outcomes, after teer for mr. Methods: in a multicenter observational cohort study, patients who underwent teer were stratified by sex and relevant outcome measures, and analyzed using multivariable cox regression and propensity score matching (psm). Results: a total of 821 patients were analyzed, of whom 37.4% (307/821) were female. compared to male patients, females were significantly older (77 ± 8.5 vs. 80.4 ± 6.7 years, p = 0.03), and had less coronary artery disease (cad, 67.7% vs. 53.1%, p < 0.0001) and a higher proportion of preserved left ventricular function (lvef > 50%, 32.5% vs. 50.5%, p > 0.0001). safety and efficacy of the teer procedure and in-hospital mortality did not differ between the sexes. after psm, women showed significantly better survival 3 years after teer compared to men (60.7% vs. 54.2%, p = 0.04) and a lower risk of all-cause death according to multiple cox regression (hr 0.8, 95% ci 0.6–0.9, p = 0.02). after sex-specific stratification for concomitant atrial fibrillation (af), the most common comorbidity in the present collective, women with af experience significantly worse adjusted survival compared to women without af (53.9% vs. 75.1%, p = 0.042) three years after teer and lose the survival advantage over men. Conclusions: female patients are older and less comorbid than males undergoing TEER. The TEER procedure is equally safe and effective in both sexes. While in-hospital mortality did not differ, female patients experienced a significantly better adjusted long-term survival compared to male patients. Concomitant AF offsets the prognostic advantage of females over males and, in contrast to males, significantly impairs long-term survival in women undergoing TEER. Further research is warranted to elucidate underlying causes for the observed sex disparities and to develop sex-tailored treatment recommendations.

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Sex Differences in Epidemiology, Morphology, Mechanisms, and Treatment of Mitral Valve Regurgitation

Cited by 9 publications

References 64 publications

Technical and Clinical Outcomes After Transcatheter Edge‐to‐Edge Repair of Mitral Regurgitation in Male and Female Patients: Is Equality Achieved?

Technical and Clinical Outcomes After Transcatheter Edge‐to‐Edge Repair of Mitral Regurgitation in Male and Female Patients: Is Equality Achieved?

Identification and Analysis of Sex-Biased MicroRNAs in Human Diseases

Sex-Specific Disparities in Outcomes of Transcatheter Edge-to-Edge Repair for Mitral Regurgitation: A Multicenter “Real-World” Analysis

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