Background: The prevalence of severe calcific mitral stenosis (MS) is higher in female patients. The aim of the study was to assess the sex-related differences in clinical characteristics and prognosis in patients with severe calcific MS.
Methods: Among 7154 adult patients with MS due to mitral annular calcification who underwent echocardiography between October 2010 and August 2020, 287 patients with severe MS were retrospectively analyzed. The endpoint was all-cause mortality. We calculated a propensity score matched analysis with 22 potential confounding covariates including clinical characteristics and medication usage.
Results: In the entire cohort, there was a predominance of female patients (66 %), and the mean age was 72 ± 11 years. While 97 patients (34 %) underwent MV intervention, 190 patients (66 %) were conservatively managed. During a median follow-up of 12 months (25th -75th percentile: 3-29 months), 102 patients (36 %) died. The cumulative survival rate of female patients was lower compared with male patients in conservative treatment group (p = 0.012), while the cumulative survival rate was comparable between the sexes in MV intervention group (p = 0.63). Even after propensity score matching in 170 patients (85 females and 85 males), similar results were obtained (p = 0.012 for conservative treatment group, p = 0.61 for MV intervention group).
Conclusions: Female sex predominated in patients with severe calcific MS. Female patients with severe calcific MS had worse prognosis than male patients when treated conservatively, while in patients undergoing MV intervention, prognosis was similar between the sexes.
Keywords: Mitral annular calcification; Mitral stenosis; Propensity score matching; Sex-related differences.
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