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Wang C, Song M, Chen H, Liang P, Luo G, Ren W, Yang S. Global Epidemiologic Trends and Projections to 2030 in Non-Rheumatic Degenerative Mitral Valve Disease from 1990 to 2019: An Analysis of the Global Burden of Disease Study 2019. Rev Cardiovasc Med 2024; 25:269. [PMID: 39139442 PMCID: PMC11317355 DOI: 10.31083/j.rcm2507269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 01/07/2024] [Accepted: 01/17/2024] [Indexed: 08/15/2024] Open
Abstract
Background No studies have updated the epidemiologic changes in non-rheumatic degenerative mitral valve disease (DMVD) since 2019, thus this study utilized data from the Global Study of Diseases, Injuries, and Risk Factors 2019 (GBD2019) to assess the burden of DMVD in 204 countries and territories over the period 1990-2019, as well as changes in the prevalence, incidence, deaths and changes in disability-adjusted life years (DALYs). Methods Using the results from the GBD2019, analyzing the incidence, prevalence, deaths, and DALYs rates, as well as their age-standardized rates (ASR). Based on the human development index (HDI), the socio-demographic index (SDI), age, and sex. Results In 2019, there were 24.229 million (95% uncertainty interval (UI) 23.081-25.419 million) existing cases of DMVD worldwide, with 1.064 million (95% UI 1.010-1.122 million) new cases and 0.034 million (95% UI 0.028-0.043 million) deaths, and 0.883 million (95% UI 0.754-1.092 million) disability-adjusted life years. The incidence, prevalence, deaths, and DALYs of DMVD and their ASR showed significant differences across sex, age groups, regions, and countries from 1990 to 2019. It is projected that by 2030, the incidence of DMVD in females will be 0.72 million with an ASR of 15.59 per 100,000 population, 0.51 million in males with an ASR of 11.75 per 100,000 population, and a total incidence of 1.23 million with an ASR of 14.03 per 100,000 population. Conclusions DMVD remains a significant public health problem that cannot be ignored, despite a decreasing trend in the ASR of global incidence, prevalence, deaths and DALYs from 1990 to 2019. However, we note an adverse development trend in countries with low socio-demographic indexes and seriously aging societies, and sex inequality is particularly prominent. This indicates the need to reposition current prevention and treatment strategies, with some national health administrations developing corresponding strategies for preventing an increase in DMVD based on local health, education, economic conditions, sex differences, and age differences.
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Affiliation(s)
- Chengmei Wang
- College of Integrative Medicine, Southwest Medical University, 646000 Luzhou, Sichuan, China
| | - Menglin Song
- College of Integrative Medicine, Southwest Medical University, 646000 Luzhou, Sichuan, China
| | - Hao Chen
- College of Integrative Medicine, Southwest Medical University, 646000 Luzhou, Sichuan, China
| | - Pan Liang
- The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, 646000 Luzhou, Sichuan, China
| | - Gang Luo
- The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, 646000 Luzhou, Sichuan, China
| | - Wei Ren
- The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, 646000 Luzhou, Sichuan, China
| | - Sijin Yang
- The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, 646000 Luzhou, Sichuan, China
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2
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Foley O, Hammond R, Au K, Asghar N, Tauseef A, Jabbar ABA, Millner P, Mirza M. Disparities in Mitral Valve Disease Associated with Heart Failure. Rev Cardiovasc Med 2024; 25:129. [PMID: 39076558 PMCID: PMC11264015 DOI: 10.31083/j.rcm2504129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 07/31/2024] Open
Abstract
Heart failure (HF) affects millions of people around the world and is a prevalent health issue in the United States. In many cases, HF has an intricate connection with mitral valvular disease (MVD), which can alter a patient's disease course. Factors such as gender, race, ethnicity, and social determinants of health impact the prevalence, etiology, and treatment of MVD associated with HF. This literature review examines the connection between MVD and HF among adult patients, considering MVD as both a cause and an outcome of HF. This article also identifies the differences in epidemiology and treatment of MVD associated with HF across different gender, ethnicity, race, and socioeconomic groups. This is in an effort to not only identify currently overlooked disparities but to highlight potential ways to improve them. MVD was analyzed based on its hemodynamic subtypes, mitral regurgitation (MR) and mitral stenosis (MS), as these subtypes encompass different etiologies of MVD. The purpose of this article was to identify broad disparities in MVD in association with HF in the adult population. The results of this study found stark differences between prevalence, treatment, and disease outcomes across groups. Women and Black patients were identified as high-risk for under-utilization and prescription delay of treatment options. Women were often treated at more advanced stages of MVD, while treatment was often delayed in Black patient populations. Factors such as these impact treatment outcomes. Conversely, men and White patients were identified as lower-risk groups for treatment inadequacies and poor HF and MVD related outcomes. Socioeconomic status (SES) was also found to play a role, with low SES being a risk factor for developing rheumatic heart disease. Low SES groups are also more likely to develop HF, which predisposes to secondary MR. Despite general knowledge of these disparities, few studies analyze HF and MVD for specific groups. This literature review is thus necessary to identify current inequities in care and underscore potential solutions to raise awareness for further research efforts and funding. This analysis identifies MVD treatment guidelines and contributing social determinants of health as areas that must be addressed to minimize HF and MVD disparities.
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Affiliation(s)
- Olivia Foley
- Creighton University School of Medicine, Omaha, NE 68178, USA
| | - Rebecca Hammond
- Creighton University School of Medicine, Omaha, NE 68178, USA
| | - Kristine Au
- Creighton University School of Medicine, Phoenix, AZ 85012, USA
| | - Noureen Asghar
- Internal Medicine, Creighton University Medical Center – Bergan Mercy, Omaha, NE 68124, USA
| | - Abubakar Tauseef
- Internal Medicine, Creighton University Medical Center – Bergan Mercy, Omaha, NE 68124, USA
| | - Ali Bin Abdul Jabbar
- Internal Medicine, Creighton University Medical Center – Bergan Mercy, Omaha, NE 68124, USA
| | - Paul Millner
- Internal Medicine, Creighton University Medical Center – Bergan Mercy, Omaha, NE 68124, USA
| | - Mohsin Mirza
- Internal Medicine, Creighton University Medical Center – Bergan Mercy, Omaha, NE 68124, USA
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3
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Gomes B, Singh A, O'Sullivan JW, Schnurr TM, Goddard PC, Loong S, Amar D, Hughes JW, Kostur M, Haddad F, Salerno M, Foo R, Montgomery SB, Parikh VN, Meder B, Ashley EA. Genetic architecture of cardiac dynamic flow volumes. Nat Genet 2024; 56:245-257. [PMID: 38082205 DOI: 10.1038/s41588-023-01587-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/23/2023] [Indexed: 02/04/2024]
Abstract
Cardiac blood flow is a critical determinant of human health. However, the definition of its genetic architecture is limited by the technical challenge of capturing dynamic flow volumes from cardiac imaging at scale. We present DeepFlow, a deep-learning system to extract cardiac flow and volumes from phase-contrast cardiac magnetic resonance imaging. A mixed-linear model applied to 37,653 individuals from the UK Biobank reveals genome-wide significant associations across cardiac dynamic flow volumes spanning from aortic forward velocity to aortic regurgitation fraction. Mendelian randomization reveals a causal role for aortic root size in aortic valve regurgitation. Among the most significant contributing variants, localizing genes (near ELN, PRDM6 and ADAMTS7) are implicated in connective tissue and blood pressure pathways. Here we show that DeepFlow cardiac flow phenotyping at scale, combined with genotyping data, reinforces the contribution of connective tissue genes, blood pressure and root size to aortic valve function.
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Affiliation(s)
- Bruna Gomes
- Departments of Medicine, Genetics, Computer Science and Biomedical Data Science, Stanford University, Stanford, CA, USA
- Department of Cardiology, Pneumology and Angiology, Heidelberg University Hospital, Heidelberg, Germany
- Informatics for Life, Heidelberg, Germany
| | - Aditya Singh
- Departments of Medicine, Genetics, Computer Science and Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Jack W O'Sullivan
- Departments of Medicine, Genetics, Computer Science and Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Theresia M Schnurr
- Departments of Medicine, Genetics, Computer Science and Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Pagé C Goddard
- Departments of Medicine, Genetics, Computer Science and Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Shaun Loong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - David Amar
- Departments of Medicine, Genetics, Computer Science and Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - J Weston Hughes
- Departments of Medicine, Genetics, Computer Science and Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Mykhailo Kostur
- Department of Cardiology, Pneumology and Angiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Francois Haddad
- Departments of Medicine, Genetics, Computer Science and Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Michael Salerno
- Departments of Medicine, Genetics, Computer Science and Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Roger Foo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Stephen B Montgomery
- Departments of Medicine, Genetics, Computer Science and Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Victoria N Parikh
- Departments of Medicine, Genetics, Computer Science and Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Benjamin Meder
- Department of Cardiology, Pneumology and Angiology, Heidelberg University Hospital, Heidelberg, Germany
- Informatics for Life, Heidelberg, Germany
| | - Euan A Ashley
- Departments of Medicine, Genetics, Computer Science and Biomedical Data Science, Stanford University, Stanford, CA, USA.
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Mulvagh SL, Colella TJ, Gulati M, Crosier R, Allana S, Randhawa VK, Bruneau J, Pacheco C, Jaffer S, Cotie L, Mensour E, Clavel MA, Hill B, Kirkham AA, Foulds H, Liblik K, Van Damme A, Grace SL, Bouchard K, Tulloch H, Robert H, Pike A, Benham JL, Tegg N, Parast N, Adreak N, Boivin-Proulx LA, Parry M, Gomes Z, Sarfi H, Iwegim C, Van Spall HG, Nerenberg KA, Wright SP, Limbachia JA, Mullen KA, Norris CM. The Canadian Women's Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women - Chapter 9: Summary of Current Status, Challenges, Opportunities, and Recommendations. CJC Open 2024; 6:258-278. [PMID: 38487064 PMCID: PMC10935707 DOI: 10.1016/j.cjco.2023.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/03/2023] [Indexed: 03/17/2024] Open
Abstract
This final chapter of the Canadian Women's Heart Health Alliance "ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women" presents ATLAS highlights from the perspective of current status, challenges, and opportunities in cardiovascular care for women. We conclude with 12 specific recommendations for actionable next steps to further the existing progress that has been made in addressing these knowledge gaps by tackling the remaining outstanding disparities in women's cardiovascular care, with the goal to improve outcomes for women in Canada.
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Affiliation(s)
- Sharon L. Mulvagh
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Tracey J.F. Colella
- KITE-UHN-Toronto Rehabilitation, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Martha Gulati
- Barbra Streisand Women’s Heart Center, Cedars Sinai Heart Institute, Los Angeles, California, USA
| | - Rebecca Crosier
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | | | - Jill Bruneau
- Memorial University, St John's, Newfoundland and Labrador, Canada
| | - Christine Pacheco
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Shahin Jaffer
- Department of Medicine, Division of Community Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa Cotie
- KITE-UHN-Toronto Rehabilitation, Toronto, Ontario, Canada
| | - Emma Mensour
- University of Western Ontario, London, Ontario, Canada
| | | | - Braeden Hill
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Amy A. Kirkham
- KITE-UHN-Toronto Rehabilitation, Toronto, Ontario, Canada
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Heather Foulds
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kiera Liblik
- Department of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Andrea Van Damme
- University of Alberta Faculty of Graduate & Postdoctoral Studies, Edmonton, Alberta, Canada
| | - Sherry L. Grace
- York University and University Health Network, Toronto, Ontario, Canada
| | - Karen Bouchard
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Heather Tulloch
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Helen Robert
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - April Pike
- Memorial University, St John's, Newfoundland and Labrador, Canada
| | - Jamie L. Benham
- Departments of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nicole Tegg
- Faculties of Nursing, Medicine, and School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Nazli Parast
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Najah Adreak
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Zoya Gomes
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Hope Sarfi
- Canadian Women’s Heart Health Alliance, Ottawa, Ontario, Canada
| | - Chinelo Iwegim
- Fraser Health Authority, Surrey, British Columbia, Canada
| | - Harriette G.C. Van Spall
- Departments of Medicine and Health Research Methods, Evidence, and Impact, Research Institute of St Joe’s, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Kara A. Nerenberg
- Departments of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | | | | | - Colleen M. Norris
- Faculties of Nursing, Medicine, and School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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5
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Abadie BQ, Cremer PC, Vakamudi S, Gillinov AM, Svensson LG, Cho L. Sex-Specific Prognosis of Left Ventricular Size and Function Following Repair of Degenerative Mitral Regurgitation. J Am Coll Cardiol 2024; 83:303-312. [PMID: 38199708 DOI: 10.1016/j.jacc.2023.10.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/29/2023] [Accepted: 10/13/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Prior studies have demonstrated worse long-term outcomes for women after surgery for severe mitral regurgitation (MR). The current Class I indications for surgery for severe degenerative MR use cutoffs of left ventricular end-systolic dimension (LVESD) and left ventricular ejection fraction (EF) that do not account for known sex-related differences. OBJECTIVES The primary objective of this study was to assess long-term mortality following mitral valve repair in women compared with men on the basis of preoperative left ventricular systolic dimensions and EF. METHODS Consecutive patients who underwent isolated mitral valve repair for degenerative MR at a single institution between 1994 and 2016 were screened. Adjusted HRs for all-cause mortality were compared according to baseline LVESD, LVESD indexed to body surface area (LVESDi), and EF for men and women. RESULTS Among 4,589 patients, 1,825 were women (40%), and after a median follow-up period of 7.2 years, 344 patients (7.5%) had died. The risk for mortality for women increased from the baseline hazard at an LVESD of 3.6 cm, whereas an inflection point for increased risk with LVESD was not evident in men. Regarding LVESDi, the risk for women increased at 1.8 cm/m2 compared with 2.1 cm/m2 in men. For EF, women and men had a similar inflection point (58%); however, mortality was higher for women as EF decreased. CONCLUSIONS After mitral valve repair, women have a higher risk for all-cause mortality at lower LVESD and LVESDi and higher EF. These results support consideration of sex-specific thresholds for LVESDi in surgical decision making for patients with severe MR.
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Affiliation(s)
- Bryan Q Abadie
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Paul C Cremer
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sneha Vakamudi
- Ascension Texas Cardiovascular and the University of Texas at Austin Dell Medical School, Austin, Texas, USA
| | - A Marc Gillinov
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lars G Svensson
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Leslie Cho
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
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6
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Zinoviev R, Hasan RK, Gammie JS, Resar JR, Czarny MJ. Economic Burden of Inpatient Care for Mitral Regurgitation in Maryland. J Am Heart Assoc 2024; 13:e029875. [PMID: 38214264 PMCID: PMC10926798 DOI: 10.1161/jaha.123.029875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 10/16/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Mitral regurgitation (MR) is the most common valvular disease in the United States and increases the risk of death and hospitalization. The economic burden of MR in the United States is not known. METHODS AND RESULTS We analyzed inpatient hospitalization data from the 1 221 173 Maryland residents who had any in-state admissions from October 1, 2015, to September 30, 2019. We assessed the total charges for patients without MR and for patients with MR who underwent medical management, transcatheter mitral valve repair or replacement, or surgical mitral valve repair or replacement. During the study period, 26 076 inpatients had a diagnosis of MR. Compared with patients without MR, these patients had more comorbidities and higher inpatient mortality. Patients with medically managed MR incurred average total charges of $23 575 per year; MR was associated with $10 559 more in charges per year and an incremental 3.1 more inpatient days per year as compared with patients without MR. Both surgical mitral valve repair or replacement and transcatheter mitral valve repair or replacement were associated with higher charges as compared with medical management during the year of intervention ($47 943 for surgical mitral valve repair or replacement and $63 108 for transcatheter mitral valve repair or replacement). Annual charges for both groups were significantly lower as compared with medical management in the second and third years postintervention. CONCLUSIONS MR is associated with higher mortality and inpatient charges. Patients who undergo surgical or transcatheter intervention incur lower charges compared with medically managed MR patients in the years after the procedure.
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Affiliation(s)
| | - Rani K. Hasan
- Division of Cardiology, Johns Hopkins University School of MedicineBaltimoreMD
| | - James S. Gammie
- Division of Cardiac SurgeryJohns Hopkins University School of MedicineBaltimoreMD
| | - Jon R. Resar
- Division of Cardiology, Johns Hopkins University School of MedicineBaltimoreMD
| | - Matthew J. Czarny
- Division of Cardiology, Johns Hopkins University School of MedicineBaltimoreMD
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7
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Tersalvi G, Gaiero L, Capriolo M, Cristoforetti Y, Salizzoni S, Senatore G, Pedrazzini G, Biasco L. Sex Differences in Epidemiology, Morphology, Mechanisms, and Treatment of Mitral Valve Regurgitation. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1017. [PMID: 37374220 DOI: 10.3390/medicina59061017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023]
Abstract
Sex-related disparities have been recognized in incidence, pathological findings, pathophysiological mechanisms, and diagnostic pathways of non-rheumatic mitral regurgitation. Furthermore, access to treatments and outcomes for surgical and interventional therapies among women and men appears to be different. Despite this, current European and US guidelines have identified common diagnostic and therapeutic pathways that do not consider patient sex in decision-making. The aim of this review is to summarize the current evidence on sex-related differences in non-rheumatic mitral regurgitation, particularly regarding incidence, imaging modalities, surgical-derived evidence, and outcomes of transcatheter edge-to-edge repair, with the goal of informing clinicians about sex-specific challenges to consider when making treatment decisions for patients with mitral regurgitation.
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Affiliation(s)
- Gregorio Tersalvi
- Department of Cardiology, Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
- Department of Internal Medicine, Ente Ospedaliero Cantonale, 6850 Mendrisio, Switzerland
| | - Lorenzo Gaiero
- Division of Cardiology, Azienda Sanitaria Locale Torino 4, Ospedale di Ciriè, 10073 Ciriè, Italy
| | - Michele Capriolo
- Division of Cardiology, Azienda Sanitaria Locale Torino 4, Ospedale di Ciriè, 10073 Ciriè, Italy
| | - Yvonne Cristoforetti
- Division of Cardiology, Ospedale Gradenigo, Humanitas Torino, 10153 Turin, Italy
| | - Stefano Salizzoni
- Division of Cardiac Surgery, Città della Salute e della Scienza, Università degli Studi di Torino, 10126 Turin, Italy
| | - Gaetano Senatore
- Division of Cardiology, Azienda Sanitaria Locale Torino 4, Ospedale di Ciriè, 10073 Ciriè, Italy
| | - Giovanni Pedrazzini
- Department of Cardiology, Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Luigi Biasco
- Division of Cardiology, Azienda Sanitaria Locale Torino 4, Ospedale di Ciriè, 10073 Ciriè, Italy
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
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8
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Aurigemma C, Burzotta F, Trani C. Heart valve disease gender difference in the era of transcatether treatment. HEART, VESSELS AND TRANSPLANTATION 2023. [DOI: 10.24969/hvt.2023.375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Available data have demonstrated important sex-related differences in patients with valvular heart disease, regarding clinical presentation, treatment, and outcomes. Although the calcific aortic stenosis (AS) is more frequent in men compared to women, the majority of AS patients over 80 years old are women, in whom fibrotic remodeling of aortic valve is typically found. Mitral valve disease is more common in women. However females are under-referred or delayed referrals to treatment, probably due to the absence of sex-based LV dimension values guiding surgical timing. The development of transcatheter devices have revolutionized the treatment of valvular heart disease and increased the interest in this topic.
In this context, the consideration of gender differences in presentation, diagnosis, treatment success, and prognosis is of great importance.
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9
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Yi K, Gao J, Wang WX, Ma YH, Wang W, He SE, Xu XM, Li PF, You T. Gender-related differences on outcome following transcatheter mitral valve repair (TMVR): a systematic review and meta-analysis. J Cardiothorac Surg 2023; 18:31. [PMID: 36650548 PMCID: PMC9843892 DOI: 10.1186/s13019-023-02123-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 01/02/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The effect of gender on patients with mitral valve regurgitation (MR) undergoing transcatheter mitral valve repair (TMVR) remains to be defined. The aim of the present study is a comprehensive meta-analysis of studies that investigate differences between men and women after TMVR. METHODS A systematic literature search was carried out on eight databases to collect all relevant studies on gender-related outcomes of TMVR before March 1, 2021. The main outcomes of interest were mortality, cardiac function, MR class and other complications. RESULTS A total of eight literatures were included, all of which were retrospective observational studies. Compared to women patients, men had lower postoperative New York Heart Association (NYHA) class (OR = 1.53, 95%CI [1.23, 1.91], P = 0.0001) and higher incidence of postoperative acute kidney injury (AKI) (OR = 1.25, 95%CI [1.16, 1.34], P < 0.05). There were no significant difference on mortality in 30 days (OR = 0.95, 95%CI [0.81, 1.11], P = 0.53) and in 2 years (OR = 0.99, 95%CI [0.75, 1.30], P = 0.93), mitral valve regurgitation (MR) class (OR = 1.30, 95%CI [0.97, 1.75], P = 0.08) and incidence of myocardial infarction (MI) (OR = 0.88, 95%CI [0.65, 1.18], P = 0.38), stroke (OR = 0.80, 95%CI [0.63, 1.02], P = 0.08) and bleeding in hospital (OR = 0.84, 95%CI [0.59, 1.19], P = 0.32). CONCLUSIONS Our meta-analysis demonstrates that men undergoing TMVR have worse preoperative diseases (diabetes mellitus, coronary artery disease, renal failure and myocardial infarction) while they have superior postoperative NYHA class at one-year. There are no significantly difference in other indexes between men and women.
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Affiliation(s)
- Kang Yi
- grid.417234.70000 0004 1808 3203Department of Cardiovascular Surgery, Gansu Province, Gansu Provincial Hospital, No. 204, Donggang West Road, Lanzhou, 730000 China ,Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China
| | - Jie Gao
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China ,grid.412643.60000 0004 1757 2902The First Clinical Medical College of Lanzhou University, Lanzhou, China ,grid.412595.eDepartment of Pediatrics, First Affiliated Hospital of SunYat-sen University, Guangzhou, China
| | - Wen-Xin Wang
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China ,grid.418117.a0000 0004 1797 6990The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, China
| | - Yu-Hu Ma
- grid.412901.f0000 0004 1770 1022Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
| | - Wei Wang
- grid.412636.40000 0004 1757 9485Department of Cardiac Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Shao E. He
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China ,grid.411294.b0000 0004 1798 9345The Second Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Xiao-Min Xu
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China ,grid.412643.60000 0004 1757 2902The First Clinical Medical College of Lanzhou University, Lanzhou, China ,grid.511083.e0000 0004 7671 2506Division of Gastroenterology, Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China
| | - Peng-Fei Li
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China ,grid.412643.60000 0004 1757 2902The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Tao You
- grid.417234.70000 0004 1808 3203Department of Cardiovascular Surgery, Gansu Province, Gansu Provincial Hospital, No. 204, Donggang West Road, Lanzhou, 730000 China ,Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China
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10
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Choi YJ, Son JW, Kim EK, Kim IC, Kim HY, Seo JS, Sun BJ, Shim CY, Yoon SJ, Lee S, Lee SH, Park JB, Kang DH. Epidemiologic Profile of Patients With Valvular Heart Disease in Korea: A Nationwide Hospital-Based Registry Study. J Cardiovasc Imaging 2023; 31:51-61. [PMID: 36693346 PMCID: PMC9880350 DOI: 10.4250/jcvi.2022.0076] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/23/2022] [Accepted: 09/13/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Valvular heart disease (VHD) is a common cause of cardiovascular morbidity and mortality worldwide; however, its epidemiological profile in Korea requires elucidation. METHODS In this nationwide retrospective cohort study from the Korean valve survey, which collected clinical and echocardiographic data on VHD from 45 medical centers, we identified 4,089 patients with VHD between September and October 2019. RESULTS The aortic valve was the most commonly affected valve (n = 1,956 [47.8%]), followed by the mitral valve (n = 1,598 [39.1%]) and tricuspid valve (n = 1,172 [28.6%]). There were 1,188 cases of aortic stenosis (AS) and 926 cases of aortic regurgitation. The most common etiology of AS was degenerative disease (78.9%). The proportion of AS increased with age and accounted for the largest proportion of VHD in patients aged 80-89 years. There were 1,384 cases of mitral regurgitation (MR) and 244 cases of mitral stenosis (MS). The most common etiologies for primary and secondary MR were degenerative disease (44.3%) and non-ischemic heart disease (63.0%), respectively, whereas rheumatic disease (74.6%) was the predominant cause of MS. There were 1,172 tricuspid regurgitation (TR) cases, of which 46.9% were isolated and 53.1% were associated with other valvular diseases, most commonly with MR. The most common type of TR was secondary (90.2%), while primary accounted for 6.1%. CONCLUSIONS This report demonstrates the current epidemiological status of VHD in Korea. The results of this study can be used as fundamental data for developing Korean guidelines for VHD.
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Affiliation(s)
- You-Jung Choi
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Korea University, Seoul, Korea
| | - Jung-Woo Son
- Division of Cardiology, Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, Korea
| | - Eun Kyoung Kim
- Division of Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - In-Cheol Kim
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Hyung Yoon Kim
- Department of Cardiovascular Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Jeong-Sook Seo
- Division of Cardiology, Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University, Busan, Korea
| | - Byung Joo Sun
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Se-Jung Yoon
- Division of Cardiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Sahmin Lee
- Division of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun Hwa Lee
- Division of Cardiology, Department of Internal Medicine, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea
| | - Jun-Bean Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Duk-Hyun Kang
- Division of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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11
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Bradley S, White RS, Jiang SY, Ma X, Hoyler MM, Muehlschlegel JD, Karamnov S, Tangel VE, Lanahan J, Rong LQ. Sex Differences in In-Hospital Mortality After Open Cardiac Valve Surgery. Anesth Analg 2022; 135:944-953. [PMID: 36029223 PMCID: PMC9588500 DOI: 10.1213/ane.0000000000006076] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Cardiac valvular disease affects millions of people worldwide and is a major cause of morbidity and mortality. Female patients have been shown to experience inferior clinical outcomes after nonvalvular cardiac surgery, but recent data are limited regarding open valve surgical cohorts. The primary objective of our study was to assess whether female sex is associated with increased in-hospital mortality after open cardiac valve operations. METHODS Utilizing the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID), we conducted a retrospective cohort study of patients who underwent open cardiac valve surgery from 2007 to 2018 in Washington, Maryland, Kentucky, and Florida; from 2007 to 2011 in California; and from 2007 to 2016 in New York. The primary objective of this study was to estimate the confounder-adjusted association between sex and in-hospital mortality (as recorded and coded by SID HCUP) after open cardiac valve surgery. We used multilevel multivariable models to account for potential confounders, including intrahospital practice patterns. RESULTS A total of 272,954 patients (108,443 women; 39.73% of sample population with mean age of 67.6 ± 14.3 years) were included in our analysis. The overall mortality rates were 3.8% for male patients and 5.1% for female patients. The confounder-adjusted odds ratio (OR) for in-hospital mortality for female patients compared to male patients was 1.41 (95% confidence interval [CI], 1.35-1.47; P < .001). When stratifying by surgical type, female patients were also at increased odds of in-hospital mortality ( P < .001) in populations undergoing aortic valve replacement (adjusted OR [aOR], 1.38; 95% CI, 1.25-1.52); multiple valve surgery (aOR, 1.38; 95% CI, 1.22-1.57); mitral valve replacement (aOR, 1.22; 95% CI, 1.12 - 1.34); and valve surgery with coronary artery bypass grafting (aOR, 1.64; 95% CI, 1.54 - 1.74; all P < .001). Female patients did not have increased odds of in-hospital mortality in populations undergoing mitral valve repair (aOR, 1.26; 95% CI, 0.98 - 1.64; P = .075); aortic valve repair (aOR, 0.87; 95% CI, 0.67 - 1.14; P = .32); or any other single valve repair (aOR, 1.10; 95% CI, 0.82 - 1.46; P = .53). CONCLUSIONS We found an association between female patients and increased confounder-adjusted odds of in-hospital mortality after open cardiac valve surgery. More research is needed to better understand and categorize these important outcome differences. Future research should include observational analysis containing granular and complete patient- and surgery-specific data.
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Affiliation(s)
- Stephanie Bradley
- From the Department of Anesthesiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Robert S White
- Department of Anesthesiology, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York
| | - Silis Y Jiang
- Department of Anesthesiology, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York
| | - Xiaoyue Ma
- Department of Anesthesiology, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York
| | - Marguerite M Hoyler
- Department of Anesthesiology, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York
| | - Jochen D Muehlschlegel
- From the Department of Anesthesiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sergey Karamnov
- From the Department of Anesthesiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Virginia E Tangel
- Department of Anesthesiology, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York
| | - Jill Lanahan
- From the Department of Anesthesiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lisa Qia Rong
- Department of Anesthesiology, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York
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12
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Jurgens CY, Lee CS, Aycock DM, Masterson Creber R, Denfeld QE, DeVon HA, Evers LR, Jung M, Pucciarelli G, Streur MM, Konstam MA. State of the Science: The Relevance of Symptoms in Cardiovascular Disease and Research: A Scientific Statement From the American Heart Association. Circulation 2022; 146:e173-e184. [PMID: 35979825 DOI: 10.1161/cir.0000000000001089] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Symptoms of cardiovascular disease drive health care use and are a major contributor to quality of life. Symptoms are of fundamental significance not only to the diagnosis of cardiovascular disease and appraisal of response to medical therapy but also directly to patients' daily lives. The primary purpose of this scientific statement is to present the state of the science and relevance of symptoms associated with cardiovascular disease. Symptoms as patient-reported outcomes are reviewed in terms of the genesis, manifestation, and similarities or differences between diagnoses. Specifically, symptoms associated with acute coronary syndrome, heart failure, valvular disorders, stroke, rhythm disorders, and peripheral vascular disease are reviewed. Secondary aims include (1) describing symptom measurement methods in research and application in clinical practice and (2) describing the importance of cardiovascular disease symptoms in terms of clinical events and other patient-reported outcomes as applicable.
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13
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Winnicki A, Gadd J, Ohanyan V, Hernandez G, Wang Y, Enrick M, McKillen H, Kiedrowski M, Kundu D, Kegecik K, Penn M, Chilian WM, Yin L, Dong F. Role of endothelial CXCR4 in the development of aortic valve stenosis. Front Cardiovasc Med 2022; 9:971321. [PMID: 36148060 PMCID: PMC9488705 DOI: 10.3389/fcvm.2022.971321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/15/2022] [Indexed: 11/24/2022] Open
Abstract
Background CXCL12/CXCR4 signaling is essential in cardiac development and repair, however, its contribution to aortic valve stenosis (AVS) remains unclear. In this study, we tested the role of endothelial CXCR4 on the development of AVS. Materials and methods We generated CXCR4 endothelial cell-specific knockout mice (EC CXCR4 KO) by crossing CXCR4fl/fl mice with Tie2-Cre mice to study the role of endothelial cell CXCR4 in AVS. CXCR4fl/fl mice were used as controls. Echocardiography was used to assess the aortic valve and cardiac function. Heart samples containing the aortic valve were stained using Alizarin Red for detection of calcification. Masson’s trichrome staining was used for the detection of fibrosis. The apex of the heart samples was stained with wheat germ agglutinin (WGA) to visualize ventricular hypertrophy. Results Compared with the control group, the deletion of CXCR4 in endothelial cells led to significantly increased aortic valve peak velocity and aortic valve peak pressure gradient, with decreased aortic valve area and ejection fraction. EC CXCR4 KO mice also developed cardiac hypertrophy as evidenced by increased diastolic and systolic left ventricle posterior wall thickness (LVPW), cardiac myocyte size, and heart weight (HW) to body weight (BW) ratio. Our data also confirmed increased microcalcifications, interstitial fibrosis, and thickened valvular leaflets of the EC CXCR4 KO mice. Conclusion The data collected throughout this study suggest the deletion of CXCR4 in endothelial cells is linked to the development of aortic valve stenosis and left ventricular hypertrophy. The statistically significant parameters measured indicate that endothelial cell CXCR4 plays an important role in aortic valve development and function. We have compiled compelling evidence that EC CXCR4 KO mice can be used as a novel model for AVS.
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Affiliation(s)
- Anna Winnicki
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown Township, OH, United States
| | - James Gadd
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown Township, OH, United States
| | - Vahagn Ohanyan
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown Township, OH, United States
| | - Gilbert Hernandez
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown Township, OH, United States
| | - Yang Wang
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown Township, OH, United States
| | - Molly Enrick
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown Township, OH, United States
| | - Hannah McKillen
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown Township, OH, United States
| | - Matthew Kiedrowski
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown Township, OH, United States
| | - Dipan Kundu
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown Township, OH, United States
| | - Karlina Kegecik
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown Township, OH, United States
| | - Marc Penn
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown Township, OH, United States
- Summa Cardiovascular Institute, Summa Health, Akron, OH, United States
| | - William M. Chilian
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown Township, OH, United States
| | - Liya Yin
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown Township, OH, United States
- Liya Yin,
| | - Feng Dong
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown Township, OH, United States
- *Correspondence: Feng Dong,
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Lucà F, Abrignani MG, Parrini I, Di Fusco SA, Giubilato S, Rao CM, Piccioni L, Cipolletta L, Passaretti B, Giallauria F, Leone A, Francese GM, Riccio C, Gelsomino S, Colivicchi F, Gulizia MM. Update on Management of Cardiovascular Diseases in Women. J Clin Med 2022; 11:1176. [PMID: 35268267 PMCID: PMC8911459 DOI: 10.3390/jcm11051176] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 02/08/2023] Open
Abstract
Cardiovascular diseases (CVD) have a lower prevalence in women than men; although, a higher mortality rate and a poorer prognosis are more common in women. However, there is a misperception of CVD female risk since women have commonly been considered more protected so that the real threat is vastly underestimated. Consequently, female patients are more likely to be treated less aggressively, and a lower rate of diagnostic and interventional procedures is performed in women than in men. In addition, there are substantial sex differences in CVD, so different strategies are needed. This review aims to evaluate the main gender-specific approaches in CVD.
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Affiliation(s)
- Fabiana Lucà
- Cardiology Department, Big Metropolitan Hospital, 89129 Reggio Calabria, Italy;
| | | | - Iris Parrini
- Cardiology Department, Ospedale Mauriziano Umberto I Hospital, 10128 Turin, Italy;
| | - Stefania Angela Di Fusco
- Clinical and Rehabilitation Cardiology Department, San Filippo Neri Hospital, ASL Roma 1, 00100 Roma, Italy; (S.A.D.F.); (F.C.)
| | - Simona Giubilato
- Division of Cardiology, Cannizzaro Hospital, 95121 Catania, Italy;
| | | | - Laura Piccioni
- Italy Cardiology Department, “G. Mazzini” Hospital, 64100 Teramo, Italy;
| | - Laura Cipolletta
- Division of Cardiology, Department of Cardiovascular Sciences, University of Ancona, 60126 Ancona, Italy;
| | - Bruno Passaretti
- Rehabilitation Cardiology Department, Humanitas Gavazzeni, 24125 Bergamo, Italy;
| | - Francesco Giallauria
- Department of Translational Medical Sciences, Federico II University of Naples, 80138 Naples, Italy;
| | - Angelo Leone
- Cardiology Division, Annunziata Hospital Cosenza, 87100 Cosenza, Italy;
| | | | - Carmine Riccio
- Division of Clinical Cardiology, ‘Sant’Anna e San Sebastiano’ Hospital, 81100 Caserta, Italy;
| | - Sandro Gelsomino
- Cardio Thoracic Department, Maastricht University, 6202 AZ Maastricht, The Netherlands;
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Department, San Filippo Neri Hospital, ASL Roma 1, 00100 Roma, Italy; (S.A.D.F.); (F.C.)
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15
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Abstract
As populations age worldwide, the burden of valvular heart disease has grown exponentially, and so has the proportion of affected women. Although rheumatic valve disease is declining in high-income countries, degenerative age-related causes are rising. Calcific aortic stenosis and degenerative mitral regurgitation affect a significant proportion of elderly women, particularly those with comorbidities. Women with valvular heart disease have been underrepresented in many of the landmark studies which form the basis for guideline recommendations. As a consequence, surgical referrals in women have often been delayed, with worse postoperative outcomes compared with men. As described in this review, a more recent effort to include women in research studies and clinical trials has increased our knowledge about sex-based differences in epidemiology, pathophysiology, diagnostic criteria, treatment options, outcomes, and prognosis.
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Affiliation(s)
| | - Joanna Chikwe
- Department of Cardiac Surgery, Smidt Heart Institute at Cedars-Sinai, Los Angeles, CA (J.C.)
| | - Rebecca T Hahn
- Division of Cardiology, New York Presbyterian Columbia Heart Valve Center, Columbia University Medical Center (R.T.H.)
| | - Judy W Hung
- Division of Cardiology, Harvard Medical School, Massachusetts General Hospital, Boston (J.W.H.)
| | - Francesca N Delling
- Division of Cardiology, University of California, San Francisco (J.T.D., F.N.D.)
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16
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Saeed S, Smith J, Grigoryan K, Freitas D, Bleie Ø, Chambers JB, Rajani R. Sex differences in right ventricular systolic function and all-cause mortality in tricuspid regurgitation. Cardiology 2022; 147:453-460. [PMID: 35168238 DOI: 10.1159/000522587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 02/08/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Sex-differences have been poorly studied in patients with right-sided heart valve disease. The principal aim of the current study was to explore the impact of sex-differences on right ventricular (RV) hemodynamics and all-cause mortality in patients with moderate or severe tricuspid regurgitation (TR). METHODS This is a retrospective study of 209 patients with significant TR. All patients were clinically profiled at baseline and underwent a transthoracic echocardiogram. The cohort was followed up for clinical events for a median duration of 80 months (mean±SD 69.4±33.4months). RESULTS There were 117 women with a mean (±SD) age of 72.6±13years and 92 men with a mean (±SD) age of 70.8±15.8years. There were no sex-differences between the individual measures of RV systolic function (tricuspid annulus plane systolic excursion [TAPSE], systolic pulmonary artery pressure [SPAP] and RV S'), but overall RV systolic dysfunction (TAPSE <16mm and/or RV S' <10cm/s) and LVEF <50% were more common in men. Mean (±SD) RV wall tension (RVWT) was 3170±1220 mmHg x mm in women and 3817±1499 mmHg x mm in men (p=0.002). There was no difference in all-cause mortality between women and men (Log-Rank p=0.528). Age and increased RVWT were independent predictors of all-cause mortality both in women (HR 2.61) and men (HR 3.01). CONCLUSIONS In this cohort of patients with significant TR, women more frequently had preserved RV systolic function than men. There was no sex-difference in all-cause mortality. An increased RVWT and higher age were independent predictors of all-cause mortality in both women and men.
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Affiliation(s)
- Sahrai Saeed
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Cardiothoracic Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Jenna Smith
- Cardiothoracic Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Karine Grigoryan
- Cardiothoracic Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Dario Freitas
- Cardiothoracic Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Øyvind Bleie
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - John B Chambers
- Cardiothoracic Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Ronak Rajani
- Cardiothoracic Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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17
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Elbadawi A, Tan BEX, Sammour Y, Saad M, Omer M, Baron SJ, Sharaf B, Abbott JD, Gordon PC. Sex-related differences in the trends and outcomes of trans-septal transcatheter mitral valve replacement: Insights from the National Readmissions Database. Catheter Cardiovasc Interv 2022; 99:1636-1644. [PMID: 35132765 DOI: 10.1002/ccd.30072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/26/2021] [Accepted: 12/25/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND There is a paucity of data regarding the sex-related differences in the trends and outcomes of trans-septal transcatheter mitral valve replacement (TS-TMVR). METHODS The Nationwide Readmissions Database (2015-2018) was queried for admissions for TS-TMVR. Propensity matched analysis was conducted to compare outcomes with hospitalizations for TS-TMVR among women versus men. The main study outcome was in-hospital mortality. RESULTS Our final analysis included 2063 hospitalizations for TS-TMVR; of whom, 58.1% were women. The proportion of women among those undergoing TS-TMVR increased from 50% in 2015 to 60.2% in 2018 (Ptrend = 0.04). Compared with men, women undergoing TS-TMVR were slightly younger, and had a distinct profile of comorbidities. After matching, there was no significant difference in in-hospital mortality among women versus men undergoing TS-TMVR (7.8% vs. 6.1%, OR = 1.30; 95% CI: 0.79-2.13). Subgroup analyzes showed an interaction toward higher mortality with women versus men among patients with CKD (Pinteraction = 0.07). There were no significant differences between women and men in in-hospital complications or length of stay after TS-TMVR. Compared with men, women undergoing TS-TMVR were more likely to be discharged to a nursing facility (17.7% vs. 11.5%, p = 0.01) and had higher rates of 30-day readmissions (22.4% vs. 13.6%, p = 0.01). CONCLUSION This nationwide analysis showed an increase in the proportion of women among patients undergoing TS-TMVR during the study years. There were no differences in in-hospital mortality, in-hospital complications, or length of stay between both sexes following TS-TMVR. Women were more likely to be discharged to nursing facilities and had higher rates of readmission at 30 days even after propensity matching.
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Affiliation(s)
- Ayman Elbadawi
- Division of Cardiology, Baylor College of Medicine, Houston, Texas, USA
| | - Bryan E-Xin Tan
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA
| | - Yasser Sammour
- Department of Internal Medicine, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Marwan Saad
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Mohamed Omer
- Division of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Suzanne J Baron
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Barry Sharaf
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - J Dawn Abbott
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Paul C Gordon
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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18
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Bansal A, Cremer PC, Jaber WA, Rampersad P, Menon V. Sex Differences in the Utilization and Outcomes of Cardiac Valve Replacement Surgery for Infective Endocarditis: Insights From the National Inpatient Sample. J Am Heart Assoc 2021; 10:e020095. [PMID: 34632795 PMCID: PMC8751869 DOI: 10.1161/jaha.120.020095] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The data on the differential impact of sex on the utilization and outcomes of valve replacement surgery for infective endocarditis are limited to single‐center and small sample size patient population. Methods and Results We utilized the National Inpatient Sample database to identify patients with a discharge diagnosis of infective endocarditis from 2004 to 2015 to assess differences in the characteristics and clinical outcomes of patients hospitalized with infective endocarditis stratified by sex. We also evaluated trends in utilization of cardiac valve replacement and individual valve replacement surgeries in women versus men over a 12‐year period, and compared in‐hospital mortality after surgical treatment in women versus men. A total of 81 942 patients were hospitalized with a primary diagnosis of infective endocarditis from January 2004 to September 2015, of whom 44.31% were women. Women were less likely to undergo overall cardiac valve replacement (6.92% versus 12.12%), aortic valve replacement (3.32% versus 8.46%), mitral valve replacement (4.60% versus 5.57%), and combined aortic and mitral valve replacement (0.85% versus 1.81%) but had similar in‐hospital mortality rates. From 2004 to 2015, the overall rates of cardiac valve replacement increased from 11.76% to 13.96% in men and 6.34% to 9.26% in women and in‐hospital mortality declined in both men and women. Among the patients undergoing valve replacement surgery, in‐hospital mortality was higher in women (9.94% versus 6.99%, P<0.001). Conclusions Despite increased utilization of valve surgery for infective endocarditis in both men and women and improving trends in mortality, we showed that there exists a treatment bias with underutilization of valve surgeries for infective endocarditis in women and demonstrated that in‐hospital mortality was higher in women undergoing valve surgery in comparison to men.
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Affiliation(s)
- Agam Bansal
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Foundation Cleveland OH
| | - Paul C Cremer
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Foundation Cleveland OH
| | - Wael A Jaber
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Foundation Cleveland OH
| | - Penelope Rampersad
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Foundation Cleveland OH
| | - Venu Menon
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Foundation Cleveland OH
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Uiterwijk M, van der Valk DC, van Vliet R, de Brouwer IJ, Hooijmans CR, Kluin J. Pulmonary valve tissue engineering strategies in large animal models. PLoS One 2021; 16:e0258046. [PMID: 34610023 PMCID: PMC8491907 DOI: 10.1371/journal.pone.0258046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 09/16/2021] [Indexed: 01/10/2023] Open
Abstract
In the last 25 years, numerous tissue engineered heart valve (TEHV) strategies have been studied in large animal models. To evaluate, qualify and summarize all available publications, we conducted a systematic review and meta-analysis. We identified 80 reports that studied TEHVs of synthetic or natural scaffolds in pulmonary position (n = 693 animals). We identified substantial heterogeneity in study designs, methods and outcomes. Most importantly, the quality assessment showed poor reporting in randomization and blinding strategies. Meta-analysis showed no differences in mortality and rate of valve regurgitation between different scaffolds or strategies. However, it revealed a higher transvalvular pressure gradient in synthetic scaffolds (11.6 mmHg; 95% CI, [7.31-15.89]) compared to natural scaffolds (4,67 mmHg; 95% CI, [3,94-5.39]; p = 0.003). These results should be interpreted with caution due to lack of a standardized control group, substantial study heterogeneity, and relatively low number of comparable studies in subgroup analyses. Based on this review, the most adequate scaffold model is still undefined. This review endorses that, to move the TEHV field forward and enable reliable comparisons, it is essential to define standardized methods and ways of reporting. This would greatly enhance the value of individual large animal studies.
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Affiliation(s)
- M. Uiterwijk
- Heart Center, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - D. C. van der Valk
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - R. van Vliet
- Faculty of medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - I. J. de Brouwer
- Faculty of medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - C. R. Hooijmans
- Department for Health Evidence Unit SYRCLE, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Anesthesiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J. Kluin
- Heart Center, Amsterdam University Medical Center, Amsterdam, The Netherlands
- * E-mail:
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Cho L, Kibbe MR, Bakaeen F, Aggarwal NR, Davis MB, Karmalou T, Lawton JS, Ouzounian M, Preventza O, Russo AM, Shroyer ALW, Zwischenberger BA, Lindley KJ. Cardiac Surgery in Women in the Current Era: What Are the Gaps in Care? Circulation 2021; 144:1172-1185. [PMID: 34606298 DOI: 10.1161/circulationaha.121.056025] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Cardiovascular disease remains the leading cause of morbidity and mortality for women in United States and worldwide. One in 3 women dies from cardiovascular disease, and 45% of women >20 years old have some form of CVD. Historically, women have had higher morbidity and mortality after cardiac surgery. Sex influences pathogenesis, pathophysiology, presentation, postoperative complications, surgical outcomes, and survival. This review summarizes current cardiovascular surgery outcomes as they pertain to women. Specifically, this article seeks to address whether sex disparities in research, surgical referral, and outcomes still exist and to provide strategies to close these gaps. In addition, with the growing population of women of reproductive age with cardiovascular disease and cardiovascular risk factors, indications for cardiac surgery arise in pregnant women. The current review will also address the unique issues associated with this special population.
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Affiliation(s)
- Leslie Cho
- Cleveland Clinic Heart and Vascular Institute, Ohio (L.C., F.B.,T.K.)
| | - Melina R Kibbe
- University of North Caroline Medical School, Chapel Hill (M.R.K.)
| | - Faisal Bakaeen
- Cleveland Clinic Heart and Vascular Institute, Ohio (L.C., F.B.,T.K.)
| | | | | | - Tara Karmalou
- Cleveland Clinic Heart and Vascular Institute, Ohio (L.C., F.B.,T.K.)
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21
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Moreira JL, Barletta PHAAS, Baucia JA. Women Undergoing Mitral Valve Replacement: A Retrospective Analysis. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.36660/ijcs.20200412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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22
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Abstract
BACKGROUND Valvular heart disease is a common health problem affecting both sexes and all age groups. Almost all guidelines are based on studies that mainly involved male patients. MAIN BODY The features of valvular heart diseases in women were essentially derived from small observational studies. These studies have shown that women differ from men in terms of the type of valve disease, pathology affecting the valve, perception of symptoms, parameters measured in echocardiography, response to drugs, surgical techniques, and postoperative outcomes. This review was conducted to demonstrate the uniqueness of valvular heart diseases in women and raise awareness about the need for sex-based randomized study designs to provide a piece of proper evidence to support suitable sex-based guidelines and recommendations. Moreover, it briefly describes the effects of pregnancy on women with valvular heart diseases and the impact of the latter on the course of pregnancy and the well-being of the mother and fetus. CONCLUSION Valvular heart diseases in women are different from those in men. Sex-based guidelines for managing valvular heart diseases are needed.
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Affiliation(s)
- Ghada Youssef
- Cardiology Department, Kasr Al Ainy Hospitals, Cairo University, Cairo, Egypt.
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23
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Woodward HJ, Zhu D, Hadoke PWF, MacRae VE. Regulatory Role of Sex Hormones in Cardiovascular Calcification. Int J Mol Sci 2021; 22:4620. [PMID: 33924852 PMCID: PMC8125640 DOI: 10.3390/ijms22094620] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/20/2021] [Accepted: 04/26/2021] [Indexed: 02/06/2023] Open
Abstract
Sex differences in cardiovascular disease (CVD), including aortic stenosis, atherosclerosis and cardiovascular calcification, are well documented. High levels of testosterone, the primary male sex hormone, are associated with increased risk of cardiovascular calcification, whilst estrogen, the primary female sex hormone, is considered cardioprotective. Current understanding of sexual dimorphism in cardiovascular calcification is still very limited. This review assesses the evidence that the actions of sex hormones influence the development of cardiovascular calcification. We address the current question of whether sex hormones could play a role in the sexual dimorphism seen in cardiovascular calcification, by discussing potential mechanisms of actions of sex hormones and evidence in pre-clinical research. More advanced investigations and understanding of sex hormones in calcification could provide a better translational outcome for those suffering with cardiovascular calcification.
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Affiliation(s)
- Holly J. Woodward
- The Roslin Institute & R(D)SVS, University of Edinburgh, Easter Bush, Midlothian EH25 9RG, UK;
| | - Dongxing Zhu
- Guangzhou Institute of Cardiovascular Disease, Guangdong Key Laboratory of Vascular Diseases, State Key Laboratory of Respiratory Disease, the Second Affiliated Hospital, Guangzhou Medical University, Guangzhou 510260, China
| | - Patrick W. F. Hadoke
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK;
| | - Victoria E. MacRae
- The Roslin Institute & R(D)SVS, University of Edinburgh, Easter Bush, Midlothian EH25 9RG, UK;
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24
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Kandula V, Kislitsina ON, Rigolin VH, Thomas JD, Malaisrie SC, Andrei AC, Ramesh A, Kruse J, Cox JL, McCarthy PM. Does gender bias affect outcomes in mitral valve surgery for degenerative mitral regurgitation? Interact Cardiovasc Thorac Surg 2021; 33:325-332. [PMID: 33893493 DOI: 10.1093/icvts/ivab090] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES This study was conducted to determine if gender bias explains the worse outcomes in women than in men who undergo mitral valve surgery for degenerative mitral regurgitation. METHODS Patients who underwent mitral valve surgery for degenerative mitral regurgitation with or without concomitant ablation surgery for atrial fibrillation were identified from the Cardiovascular Research Database of the Clinical Trial Unit of the Bluhm Cardiovascular Institute at Northwestern Memorial Hospital and were defined according to the Society of Thoracic Surgery National Adult Cardiac Surgery Database. Of the 1004 patients (33% female, mean age 62.1 ± 12.4 years; 67% male, mean age 60.1 ± 12.4 years) who met this criteria, propensity score matching was utilized to compare sex-related differences. RESULTS Propensity score matching of 540 patients (270 females, mean age 61.0 ± 12.2; 270 males, mean age 60.9 ± 12.3) demonstrated that 98% of mitral valve surgery performed in both groups was mitral valve repair and 2% was mitral valve replacement. Preoperative CHA2DS2-VASc scores were higher in women and fewer women were discharged directly to their homes. Before surgery, women had smaller left heart chambers, lower cardiac outputs, higher diastolic filling pressures and higher volume responsiveness than men. However, preoperative left ventricular and right ventricular strain values, which are normally higher in women, were similar in the 2 groups, indicating worse global strain in women prior to surgery. CONCLUSIONS The worse outcomes reported in women compared to men undergoing surgery for degenerative mitral regurgitation are misleading and not based on gender bias except in terms of referral patterns. Men and women who present with the same type and degree of mitral valve disease and similar comorbidities receive the same types of surgical procedures and experience similar postoperative outcomes. Speckle-tracking echocardiography to assess global longitudinal strain of the left and right ventricles should be utilized to monitor for myocardial dysfunction related to chronic mitral regurgitation.
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Affiliation(s)
- Viswajit Kandula
- Department of Surgery, Division of Cardiac Surgery, Feinberg School of Medicine, Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL, USA
| | - Olga N Kislitsina
- Department of Surgery, Division of Cardiac Surgery, Feinberg School of Medicine, Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL, USA.,Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL, USA
| | - Vera H Rigolin
- Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL, USA
| | - James D Thomas
- Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL, USA
| | - S Chris Malaisrie
- Department of Surgery, Division of Cardiac Surgery, Feinberg School of Medicine, Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL, USA
| | - Adin-Cristian Andrei
- Department of Preventive Medicine, Feinberg School of Medicine, Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL, USA
| | - Ashvita Ramesh
- Department of Surgery, Division of Cardiac Surgery, Feinberg School of Medicine, Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL, USA
| | - Jane Kruse
- Department of Surgery, Division of Cardiac Surgery, Feinberg School of Medicine, Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL, USA
| | - James L Cox
- Department of Surgery, Division of Cardiac Surgery, Feinberg School of Medicine, Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL, USA
| | - Patrick M McCarthy
- Department of Surgery, Division of Cardiac Surgery, Feinberg School of Medicine, Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL, USA
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25
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Fleury MA, Clavel MA. Sex and Race Differences in the Pathophysiology, Diagnosis, Treatment, and Outcomes of Valvular Heart Diseases. Can J Cardiol 2021; 37:980-991. [PMID: 33581193 DOI: 10.1016/j.cjca.2021.02.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/20/2021] [Accepted: 02/03/2021] [Indexed: 12/22/2022] Open
Abstract
Valvular heart diseases have long been considered to be similar in men and women and across races/ethnicities. Recently, studies have demonstrated major differences between sexes. Unfortunately, studies on valvular heart diseases, as on other cardiovascular diseases, are mostly performed in Caucasian men or in cohorts with a vast majority of Caucasian men. Therefore, our knowledge on valvular diseases in women and non-Caucasians remains limited. Nevertheless, aortic stenosis has been shown to be almost as prevalent in women as in men, and less prevalent in African Americans. Men appear to have a more calcified aortic valve lesion, and women tend to have a more fibrosed one. Primary mitral regurgitation is more frequent in women who have more rheumatic and Barlow etiologies, whereas men have more fibroelastic deficiency and posterior leaflet prolapse/flail. Left ventricular remodelling due to valvular heart diseases is sex related in terms of geometry and probably also in composition of the tissue. Outcomes seem to be worse in women after surgical interventions and better than or equivalent to men after transcatheter ones. Regarding other valvular heart diseases, very few studies are available: Aortic regurgitation is more frequent in men, isolated tricuspid regurgitation more frequent in women. Rheumatic valve diseases are more frequent in women and are mostly represented by mitral and aortic stenoses. Many other sex/gender- and race/ethnic-specific studies are still needed in epidemiology, pathophysiology, presentation, management, and outcomes. This review aims to report the available data on sex differences and race specificities in valvular heart diseases, with a primary focus on aortic stenosis and mitral regurgitation.
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Affiliation(s)
- Marie-Ange Fleury
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada.
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