From the Guidelines
The prevalence of mitral stenosis is significantly higher in females, with a female-to-male ratio of 2:1, as reported in the 2008 guidelines for the management of patients with valvular heart disease 1.
Key Findings:
- The ratio of women to men presenting with isolated mitral stenosis is 2:1, indicating a higher prevalence of the condition in females.
- Mitral stenosis is a continuous, progressive, lifelong disease, usually consisting of a slow, stable course in the early years followed by a progressive acceleration later in life.
- The natural history of patients with untreated mitral stenosis has been defined from studies in the 1950s and 1960s, with a 10-year survival rate of 50% to 60% depending on symptoms at presentation.
Clinical Implications:
- The higher prevalence of mitral stenosis in females highlights the need for increased awareness and potentially more thorough screening for the condition in female patients, particularly those with risk factors or symptoms suggestive of valve disease.
- Rheumatic fever, a known cause of mitral stenosis, may affect women more severely or frequently than men, contributing to the higher prevalence of the condition in females.
- Clinicians should consider the gender difference in mitral stenosis prevalence when evaluating patients, especially women, for potential heart valve disorders.
Recommendations:
- Females with symptoms suggestive of mitral stenosis, such as dyspnea or palpitations, should undergo thorough evaluation, including echocardiography, to determine the presence and severity of the condition 1.
- Clinicians should be aware of the potential for mitral stenosis in female patients, particularly those with a history of rheumatic fever or other risk factors, and provide appropriate screening and treatment to improve outcomes.
From the Research
Prevalence of Mitral Stenosis in Females
- The study 2 found that female patients had a higher prevalence of mitral stenosis, with 66.2% of the 500 consecutive patients being female.
- Another study 3 also reported a higher prevalence of severe calcific mitral stenosis in female patients, with 66% of the 287 patients being female.
- A study 4 found that mitral stenosis was more prevalent in women than men, with 76.66% of the 90 patients being female.
Comparison of Mitral Stenosis in Females and Males
- The study 2 found that female patients had a higher prevalence of associated tricuspid and pulmonary regurgitation, as well as a higher velocity and gradient of tricuspid regurgitation.
- However, male patients had a higher echocardiographic score and a smaller Doppler-derived mitral valve area 2.
- A study 5 found that women had higher Society of Thoracic Surgery risk scores, were older, and had more heart failure, coronary artery disease, and mitral stenosis than men.
- Another study 4 found that men had more severe mitral stenosis and significantly higher left atrial dilatation than women.
Clinical Implications
- The study 3 found that female patients with severe calcific mitral stenosis had worse prognosis than male patients when treated conservatively.
- However, in patients undergoing mitral valve intervention, prognosis was similar between the sexes 3.
- A study 5 found that women had longer intensive care unit and hospital stays, required more dialysis, and suffered more transient ischemic attacks and cardiac arrests postoperatively.
- The 30-day mortality rate was higher for women, but propensity score-matching indicated that surgical approaches and outcomes were comparable for men and women with similar levels of disease and co-morbidities 5.