Sex-Based Differences in One-Year Outcomes After Mitral Valve Repair for Infective Endocarditis

Abstract

Introduction This study was aimed to evaluate the sex-based differences in baseline characteristics and one-year outcomes of men and women undergoing mitral valve repair for infective endocarditis. Methods This cross-sectional study was performed at Imam Ali Hospital affiliated with the Kermanshah University of Medical Science. From March 21, 2014, to October 21, 2021, all patients who underwent mitral valve repair for infective endocarditis were enrolled in this study. Data were obtained using a checklist developed based on the study’s objectives. Independent samples t -tests, paired samples t-tests, and chi-squared test (or Fisher’s exact test) were used to assess the differences between subgroups. Results Of 75 patients, 26 were women (34.7%) and 49 were men (65.3%). Women were more likely to have diabetes mellitus (20.4% vs. 57.7%, P =0.0001), hypertension (49% vs. 80.8%, P =0.007), and hypercholesterolemia (55.1% vs. 80.8%, P =0.027). Conversely, men were more likely to have a history of smoking (38.8% vs. 7.7%, P =0.004). After one year, women had significantly higher mortality (0% vs. 7.7%, P =0.049), major adverse cardiac and cerebrovascular events (51.0 vs. 76.9, P =0.029), mitral valve reoperation (8.1% vs. 34.6%, P =0.003), and treatment failure (30.6% vs. 61.5%, P =0.009) rates than men. Conclusion Mortality, major adverse cardiac and cerebrovascular events, mitral valve reoperation, and treatment failure rates were higher in women than in men. The worse outcomes in women may be explained by their more adverse clinical risk profile.

Sex Differences in Infective Endocarditis: A Systematic Review

“…Two studies found that females typically had more comorbidities, supported by other studies' findings [12,14]. Females were more likely to have diabetes, atrial fibrillation, arterial hypertension, hypercholesterolemia, take immunosuppressants, chronic lung disease, malignancy, previous valve replacement, and psychiatric disorders like depression/bipolar disorder [14,21,26,27,31,32,39,41,43]. However, when this was crossed with females who had type 2 diabetes mellitus, females specifically had a higher incidence of dementia, atrial fibrillation, previous mitral valve disease, and previous tricuspid valve disease [43].…”

“…Two studies found that females typically had more comorbidities, supported by other studies' findings [12,14]. Females were more likely to have diabetes, atrial fibrillation, arterial hypertension, hypercholesterolemia, take immunosuppressants, chronic lung disease, malignancy, previous valve replacement, and psychiatric disorders like depression/bipolar disorder [14,21,26,27,31,32,39,41,43].…”

“…The incidence of the development of IE overall as of 2019 was an average of 7.03/100,000 person-years [12,13]. Males typically have a higher incidence than females regarding the development of IE [12,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. The incidence rate of IE in males was, on average, 11.39/100,000 person-years; in females, it was 5.24/100,000 person-years [12,24].…”

“…However, when this was crossed with females who had type 2 diabetes mellitus, females specifically had a higher incidence of dementia, atrial fibrillation, previous mitral valve disease, and previous tricuspid valve disease [43]. Compared to females, another study observed that males have a greater rate of comorbidities with a higher rate of chronic liver disease, IE on top of normally structured heart valves, underlying valve disease, peripheral vascular disease, coronary artery disease, ischemic cardiomyopathy, human immunodeficiency virus, previous procedures or intervention, coagulopathy, uncontrolled hypertension, tumors, and in most articles smoking, drinking, and drug use [14,16,21,23,26,27,31,32,39,41,42]. Specifically, males who developed IE and who also had type 2 diabetes had a higher incidence of chronic lung disease compared to females [43].…”

“…A couple of studies, however, observed that males were more likely to participate in IV substance abuse, smoking, and alcohol abuse [14,21,31,41]. Afshar et al did explain that due to their population base being in Iran, this result may be skewed as female smoking in Iran is frowned upon [14].…”