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JAMA Netw Open. 2025;8(3):e252420.

Sex-Specific Association of Left Ventricular Function With Mortality in Severe Mitral Regurgitation.

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제1저자 곽순구 · 교신저자 이승표, 김대희

PMID 40163120 PMC11959442 DOI 10.1001/jamanetworkopen.2025.2420 IF 11.7 순환기내과
소속 (4)
  1. Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
  2. Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
  3. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
  4. Center for Precision Medicine, Seoul National University Hospital, Seoul, South Korea.

Abstract

IMPORTANCE The association between left ventricular (LV) systolic dysfunction and adverse outcomes in patients with severe degenerative mitral regurgitation (MR) may vary by sex.

OBJECTIVE To investigate the sex-specific association of LV systolic function with mortality in patients with severe degenerative MR.

DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included consecutive patients who underwent surgery for severe degenerative MR at 2 tertiary hospitals in South Korea from 2006 to 2020. Preoperative LV ejection fraction (LVEF) and LV global longitudinal strain (LV-GLS) were measured, with absolute LV-GLS values reported. Patients were stratified by LVEF (≤55%, >55% to ≤60%, and >60%) and LV-GLS (<19.9%, ≥19.9% to <23.4%, and ≥23.4%) tertiles. Mortality status was verified through December 2023, with a median (IQR) follow-up duration of 8.2 (5.3-12.2) years. Data analysis was conducted in March 2024.

EXPOSURES Surgical MV repair or replacement.

MAIN OUTCOMES AND MEASURES The primary outcome was all-cause mortality after MV surgery. Restricted cubic spline (RCS) curves visualized the association between LVEF, LV-GLS, and mortality for each sex.

RESULTS Among 1686 patients, 1088 (64.5%) were men and 598 (35.5%) were women. Women were older than men (median [IQR] age, 62 [51-70] vs 54 [45-63] years) and had higher LVEF and LV-GLS than men did. During the follow-up, 220 (13.0%) deaths occurred (117 men [10.8%]; 103 women [17.2%]). In Kaplan-Meier curves, mortality in men increased in the lowest LVEF (≤55%) and LV-GLS (<19.9%) groups, whereas women exhibited an earlier increase in mortality at higher LVEF (55%-60%) and LV-GLS (19.9%-23.4%) levels. Multivariable Cox analyses showed a higher mortality risk associated with LVEF less than or equal to 55% (adjusted hazard ratio [HR], 3.48; 95% CI, 1.84-6.58; P < .001) and 55% to 60% (adjusted HR, 2.21; 95% CI, 1.36-3.58; P = .001) compared with LVEF greater than 60% in women, but not in men (P for interaction by sex = .02). RCS curves showed an earlier increase in mortality risk at higher LVEF and LV-GLS levels in women. Similar trends were observed in asymptomatic patients.

CONCLUSIONS AND RELEVANCE In this cohort study of patients with severe degenerative MR, women had an earlier increase in mortality risk associated with LV systolic dysfunction, suggesting the need to consider sex-specific criteria for early surgery in asymptomatic patients.

Figures

Figure 1.
Figure 1. Mortality According to Left Ventricular Systolic Function and Sex A, P = .35 for left ventricular ejection fraction (LVEF) 55% to 60%, and P < .001 for LVEF less than or equal to 55% (reference, LVEF >60%). B, P < .001 for LVEF 55% to 60%, and P < .001 for LVEF less than or equal to 55% (reference, LVEF >60%). C, P = .80 for left ventricular global longitudinal strain (LV-GLS) 19.9% to 23.4%, and P < .001 for LV-GLS less than 19.9% (reference, LV-GLS ≥23.4%). D, P = .08 for LV-GLS 19.9% to 23.4%, and P < .001 for LV-GLS less than 19.9% (reference, LV-GLS ≥23.4%). MV indicates mitral valve.
Figure 2.
Figure 2. Association of Left Ventricular Systolic Function With Mortality Risk by Sex Restricted cubic spline curves illustrate the associations of left ventricular ejection fraction (LVEF) and left ventricular global longitudinal strain (LV-GLS) with mortality among men and women. The hazard ratios (HRs) are adjusted for age, symptoms, atrial fibrillation, left atrial dimension, tricuspid regurgitation peak velocity, and left ventricular end-systolic dimension. Shaded areas denote 95% CIs. Dashed lines denote the null value (HR = 1).
Figure 3.
Figure 3. Association of Left Ventricular Systolic Function With Mortality Risk by Sex in Asymptomatic Individuals Restricted cubic spline curves illustrate the associations of left ventricular ejection fraction (LVEF) and left ventricular global longitudinal strain (LV-GLS) with mortality, among asymptomatic men and women. The hazard ratios (HRs) are adjusted for age, atrial fibrillation, left atrial dimension, tricuspid regurgitation peak velocity, and left ventricular end-systolic dimension. Shaded areas denote 95% CIs. Dashed lines denote the null value (HR = 1).

그림 출처: PubMed Central 공개 논문 (PMC11959442)

Conflict of interest statement

Conflict of Interest Disclosures: None reported.

그 밖의 정보
출판 형태
Journal Article, Research Support, Non-U.S. Gov't
저널
JAMA network open · eISSN 2574-3805
전자 출판
2025-03-03
MeSH
Humans · Female · Male · Mitral Valve Insufficiency* / mortality / surgery / physiopathology · Retrospective Studies · Middle Aged · Republic of Korea / epidemiology · Sex Factors · Aged · Ventricular Dysfunction, Left* / mortality / physiopathology · Ventricular Function, Left* / physiology · Stroke Volume / physiology
참고문헌
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