Gender differences in primary mitral regurgitant volumes at specific regurgitant fractions as assessed by magnetic resonance imaging

• Published in: The International Journal of Cardiovascular Imaging Vol. 38; no. 3; pp. 663 - 671
• Main Authors: House, Chad M., Xi, Min, Moriarty, Katie A., Nelson, William B.
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.03.2022; Springer Nature B.V
• Subjects: Cardiac Imaging; Cardiology; Correlation; Female; Gender; Gender aspects; Gender differences; Heart; Humans; Imaging; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medicine; Medicine & Public Health; Men; Mitral Valve Insufficiency - diagnostic imaging; Original Paper; Predictive Value of Tests; Radiology; Sex differences; Sex Factors; Stroke Volume; Ventricle; Women; Regurgitant volume; Regurgitant fraction; Mitral insufficiency; Gender; Magnetic resonance imaging
• ISSN: 1569-5794; 1573-0743; 1875-8312
• DOI: 10.1007/s10554-021-02449-z

Guidelines suggest using a regurgitant fraction of 50% and regurgitant volume of 60 ml for determination of severe mitral insufficiency. Recent MRI data has suggested that a regurgitant fraction of 40% defines severe primary mitral insufficiency. We sought to determine whether there were gender differences in primary mitral regurgitant volumes for regurgitant fractions of 40% and 50%. A database search identified 394 patients that had MRI with a mitral regurgitant volume ≥ 10 ml or a study indication of mitral insufficiency. Chart review identified 97 patients with primary mitral insufficiency. Of these patients, 53 (54%) were women. Men had significantly larger left ventricular volumes, myocardial mass, stroke volumes and mitral regurgitant volumes (37 ± 25 ml vs. 24 ± 12 ml). The difference in regurgitant fraction between genders was not significant (27 ± 14% vs. 24 ± 11%; p-value  =  0.24 ). Regurgitant fraction and regurgitant volume had a strong linear correlation in both men (r = .95) and women (r = .92). Despite similar linear correlations, the slope-intercept equations differed significantly between men and women (p < .001). A regurgitant fraction of 40% correlated with a regurgitant volume of 59 ml in men and 39.5 ml in women, while a regurgitant fraction of 50% correlated with a regurgitant volume of 76.2 ml in men and 49.6 ml in women. Regurgitant fraction, determined by cardiac MRI, provides a gender independent assessment of primary mitral insufficiency, and suggests that regurgitant volume thresholds for severe primary mitral insufficiency may be lower in women.