▲Professor Dae-Hee Kim of the Division of Cardiology at Asan Medical Center is treating a patient with severe degenerative mitral regurgitation

Degenerative mitral regurgitation is a condition in which the mitral valve, located between the left atrium and left ventricle, fails to close completely due to aging, causing blood to leak backward into the left atrium during ventricular contraction. A recent study by Professor Dae-Hee Kim of the Division of Cardiology at Asan Medical Center found that women face a higher risk of mortality than men even at the early stages of the condition.

The research team followed 1,686 patients with severe degenerative mitral regurgitation for 8.2 years, analyzing the association between gender and both left ventricular function and mortality. Left ventricular function was assessed using ‘left ventricular ejection fraction (LVEF)’, a measurement obtained through echocardiography that represents the percentage of blood pumped from the left ventricle into the aorta, and ‘left ventricular global longitudinal strain (LV-GLS)’, a more sensitive imaging marker that precisely measures the contractile function of the left ventricle. Currently, surgery is recommended regardless of gender even if LVEF falls below 60%, even in the absence of symptoms.

The research team divided patients into three groups based on LVEF, with values of 55% or below, 55 to 60%, and above 60%, and analyzed mortality rates by gender. Multivariate analysis showed that women with an LVEF of 55% or below had a 3.48-fold higher risk of mortality than those with an LVEF above 60%, while those with an LVEF between 55 and 60% had 2.2-fold increased risk. In contrast, no significant differences in mortality were observed among men across the three LVEF groups. The research team categorized patients into three groups based on their LV-GLS that are less than 19.9%, 19.9% to 23.4%, and 23.4% or more. They found that for women, as the LV-GLS decreased, the mortality rate increased. In contrast, for men, the mortality rate was higher only in the group with LV-GLS below 19.9%.

Professor Dae-Hee Kim of the Division of Cardiology commented, “LV-GLS is a valuable marker that can detect early signs of declining left ventricular function. These findings highlight the need for sex-specific guidelines for mitral valve surgery timing.”

This study was supported by the Korea Health Industry Development Institute and was recently published in the international journal ‘JAMA Network Open.’