On September 15, 2023, researchers from the University of California, San Francisco published a paper titled “Sex-based Differences in Mitral Annular Disjunction Severity and Arrhythmic Risk in Mitral Valve Prolapse” in the Journal of the American Society of Echocardiography. The study reveals the impact of gender differences on the severity of Mitral Annular Disjunction (MAD) and arrhythmic risk in patients with Mitral Valve Prolapse (MVP).
The study analyzed clinical data from 682 MVP patients between 2013 and 2023. The results showed that the absolute MAD length in male patients was significantly greater than that in female patients (9.0±3.2 mm vs. 7.3±2.6 mm), but the gender difference disappeared after body surface area (BSA) correction. The study introduced the concept of corrected MAD (iMAD) for the first time and categorized patients into three groups: no MAD, iMAD below the median (4 mm), and iMAD above the median.
Key findings indicate that iMAD > 4 mm is significantly associated with arrhythmic events in male patients (p=0.02), but has no significant impact on females (p=0.63). The risk of severe arrhythmias in female patients is more directly related to bileaflet MVP (p=0.04), while in males, it is mediated through iMAD length (p=0.03). This difference suggests that the risk stratification for arrhythmias in female MVP patients may need to consider other imaging parameters rather than solely relying on MAD length.
Male MVP patients may face a higher risk of arrhythmias related to myocardial stretch due to longer MAD, while female patients need to explore mechanisms beyond MAD. This study provides a new perspective on gender-specific risk assessment, and further validation of potential pathological mechanisms in female MVP patients is warranted.