Sex-Based Differences in Outcomes After Mitral Valve Surgery for Severe Ischemic Mitral Regurgitation: From the Cardiothoracic Surgical Trials Network

Giustino, Gennaro; Overbey, Jessica; Taylor, Doris; Ailawadi, Gorav; Kirkwood, Katherine; Gillinov, A. Marc; Dagenais, François; Mayer, Mary-Lu; Gelijns, Annetine C.; Moskowitz, Alan J.; Bagiella, Emilia; Miller, Marissa A.; Smith, Peter; O’Gara, Patrick T.; Acker, Michael A.; Lala-Trindade, Anuradha; Hung, Judy

doi:10.1016/s0735-1097(19)32557-4

Cited by 19 publications

(45 citation statements)

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“…Consideration for mitral valve (MV) surgical intervention depends on the expected outcomes associated with various preoperative and intraoperative factors, and sex has been demonstrated to influence these factors 3,4 . Preoperatively, females are referred later in the disease process, with generally higher rates of comorbidities 4–8 . Intraoperatively, there is an increased likelihood of MVR over repair for females compared with males 6–8 and an increased likelihood of concomitant procedures 4,7 .…”

Section: Introductionmentioning

confidence: 99%

“…Intraoperatively, there is an increased likelihood of MVR over repair for females compared with males 6–8 and an increased likelihood of concomitant procedures 4,7 . Postoperatively, studies have demonstrated inferior outcomes for females as compared with males in MV surgery, with up to a 2.5× increased mortality for females aged 40–59 5,6,9,10 . While it is well known that the heart remodels after MV surgery, there is little evidence on the impact of sex on cardiac remodeling post‐MV surgery.…”

Section: Introductionmentioning

confidence: 99%

“…3,4 Preoperatively, females are referred later in the disease process, with generally higher rates of comorbidities. [4][5][6][7][8] Intraoperatively, there is an increased likelihood of MVR over repair for females compared with males [6][7][8] and an increased likelihood of concomitant procedures. 4,7 Postoperatively, studies have demonstrated inferior outcomes for females as compared with males in MV surgery, with up to a 2.5× increased mortality for females aged 40-59.…”

Section: Introductionmentioning

confidence: 99%

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Impact of sex on cardiac remodeling and long‐term outcomes, following mitral valve replacement

et al. 2020

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Background: Differences in cardiac remodeling after mitral valve (MV) surgery between the sexes is poorly understood. Inferior outcomes for females undergoing MV surgery compared with males have been suggested in the literature, although causative factors behind this discrepancy have not been identified. Materials and Methods: In this propensity-matched, retrospective, single-center study, we sought to identify the impact that sex may have on cardiac remodeling and long-term outcomes to better inform clinical decision-making in MV surgical intervention. Outcomes were compared between males and females undergoing MV replacement (MVR) between 2004 and 2018. The primary outcome was cardiac remodeling 1 year postoperatively. Secondary outcomes included mortality, stroke, myocardial infarction (MI), reoperation of the MV, and rehospitalization. Results: A total of 311 males and 311 females were included after propensity matching. Both groups demonstrated significant improvement in left atrial remodeling, although only males demonstrated a significant degree of improved left ventricular remodeling while their female counterparts did not. Mortality rates were relatively equivalent between the two groups, although males were more likely to develop sepsis and require rehospitalization due to MI. Conclusions: There has been little research exploring the differences in cardiac remodeling between the sexes after MVR. The results of this study have suggested that MVR is equally safe for both sexes and has demonstrated a difference in the heart's ability to remodel after MVR. The significance of this difference has the potential to result in largely different clinical outcomes for males and females. Further study is necessary to fully elucidate this relationship.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of sex on cardiac remodeling and long‐term outcomes, following mitral valve replacement

et al. 2020

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“…androgens increase platelet activity, whereas estrogen inhibits its function (61). This may have an effect on the relative expression levels of mrna and mirna in the blood, suggesting that doctors might consider different medications for stroke patients of different sexes (62). Secondly, the data in Fig.…”

Section: Discussionmentioning

confidence: 95%

Circulating mRNA and microRNA profiling analysis in patients with ischemic stroke

Sun

Dong

et al. 2020

Mol Med Rep

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To provide insight into molecular diagnosis and individualized treatment of ischemic stroke (iS), several available datasets in iS were analyzed to identify the differentially expressed genes and micrornas (mirnas). Series matrix files from GSE22255 and GSE16561 (mRNA profiles), a well as GSE110993 (miRNA profile) were downloaded from the Gene Expression Omnibus database. System-level clustering was performed with GeneCluster 3.0 software, and gene annotation and pathway enrichment were performed with gene ontology analysis and database for annotation, Visualization and integrated discovery software. For a protein-protein interaction (PPI) network, Biological General Repository for interaction datasets and intact interaction information were integrated to determine the interaction of differentially expressed genes. The selected mirna candidates were imported into the TargetScan, mirdB and mirecords databases for the prediction of target genes. The present study identified 128 upregulated and 231 downregulated genes in female stroke patients, and 604 upregulated and 337 downregulated genes in male stroke patients compared with sex-and age-matched controls. The construction of a PPi network demonstrated that male stroke patients exhibited YWHAE, CUL3 and JUN as network center nodes, and in female patients CYLD, FOS and PIK3R1 interactions were the strongest. notably, these interactions are mainly involved in immune inflammatory response, apoptosis and other biological pathways, such as blood coagulation. Female and male upregulated genes were cross-validated with another set of Illumina HumanRef-8 v3.0 expression beadchip (GSE16561). Functional item association networks, gene function networks and transcriptional regulatory networks were successfully constructed, and the relationships between mirnas and target genes were successfully predicted. The present study identified a number of transcription factors, including DEFA1, PDK4, SDPR, TCN1 and MMP9, and miRNAs, including miRNA (miR)-21, miR-143/145, miR-125-5p and miR-122, which may serve important roles in the development of cerebral stroke and may be important molecular indicators for the treatment of iS.

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“…More recently, the first randomized control trial was conducted to study sex-based differences in outcomes after mitral valve replacement versus repair for severe ischemic MR [ 82 ]. Published in 2019, this study followed patients with 96 (38.2%) women for 2 years and demonstrated that women had smaller left ventricular volumes and effective regurgitant orifice (EROA) areas although greater EROA/left ventricular end-diastolic volume ratios.…”

Section: Structural Interventionsmentioning

confidence: 99%

Sex-Based Differences in Coronary and Structural Percutaneous Interventions

et al. 2020

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In the current state of interventional cardiology, the ability to offer advanced therapies to patients who historically were not surgical candidates has grown exponentially in the last few decades. As therapies have expanded in complex coronary and structural interventions, the nuances of treating certain populations have emerged. In particular, the role of sex-based anatomic and outcome differences has been increasingly recognized. As guidelines for cardiovascular prevention and treatment for certain conditions may vary by sex, therapeutic interventions in the structural and percutaneous coronary areas may also vary. In this review, we aim to discuss these differences, the current literature available on these topics, and areas of focus for the future.

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Sex-Based Differences in Outcomes After Mitral Valve Surgery for Severe Ischemic Mitral Regurgitation: From the Cardiothoracic Surgical Trials Network

Cited by 19 publications

References 0 publications

Impact of sex on cardiac remodeling and long‐term outcomes, following mitral valve replacement

Impact of sex on cardiac remodeling and long‐term outcomes, following mitral valve replacement

Circulating mRNA and microRNA profiling analysis in patients with ischemic stroke

Sex-Based Differences in Coronary and Structural Percutaneous Interventions

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