Heart Treatment and Your Gender

ROCHESTER, Minn. -- What's the biggest difference between the male heart and the female heart? Apparently, how it's treated in an emergency. A new study by the Mayo Clinic reveals disturbing evidence of higher mortality and lower surgery rates in women versus men with mitral valve prolapse.

Mitral valve prolapse occurs when the leaflets and supporting cords ofthe mitral valve of the heart have excessive tissue and weaken, leading to leakage (regurgitation), says senior author Maurice Enriquez-Sarano, M.D., a cardiologist at Mayo Clinic. Mitral valve prolapse affects approximately 150 million people worldwide and often requires cardiac surgery, preferably valve repair rather than replacement, to restore life expectancy of patients with severe leakage.

This retrospective study examined more than 8,000 patients (4,461 women and 3,768 men) -- all patients at Mayo Clinic diagnosed by echocardiography with mitral valve prolapse over 10 years (1989 to 1998).

"This study is significant because it allowed us to look at a large group of patients affected by mitral valve prolapse and examine subtle sex-specific differences that may have been overlooked in the past," Dr. Enriquez-Sarano says.

Disturbing differences were observed in men and women with moderate or severe regurgitation -- when the mitral valve doesn't close tightly and leaks, with blood flowing backward into the left atrium.

The study found that one of the most powerful known reasons to recommend surgery -- left ventricular size -- was poorly estimated in women because their cardiac size appeared smaller than men, but when their smaller body size was taken into account, cardiac enlargement (a measure of the severity of overload due to regurgitation) was at least as serious, Dr. Enriquez-Sarano says. Such underestimation of cardiac enlargement may have been the main reason that women with moderate or severe regurgitation were less likely than men to undergo mitral valve surgery. Importantly, this underestimation may have consequences on survival after diagnosis, he says. In the 15 years following diagnosis, survival rates among women with mitral valve prolapse and no regurgitation were better than men, but odds of survival were worse for women with severe regurgitation, compared with men.
1 2 Next
Print Article