{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T02:45:52Z","timestamp":1791254752213,"version":"4.1.0"},"reference-count":30,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>The association between left ventricular (LV) systolic dysfunction and adverse outcomes in patients with severe degenerative mitral regurgitation (MR) may vary by sex.<\/jats:p><\/jats:sec>Objective<\/jats:title>To investigate the sex-specific association of LV systolic function with mortality in patients with severe degenerative MR.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This retrospective cohort study included consecutive patients who underwent surgery for severe degenerative MR at 2 tertiary hospitals in South Korea from 2006 to 2020. Preoperative LV ejection fraction (LVEF) and LV global longitudinal strain (LV-GLS) were measured, with absolute LV-GLS values reported. Patients were stratified by LVEF (\u226455%, &amp;gt;55% to \u226460%, and &amp;gt;60%) and LV-GLS (&amp;lt;19.9%, \u226519.9% to &amp;lt;23.4%, and \u226523.4%) tertiles. Mortality status was verified through December 2023, with a median (IQR) follow-up duration of 8.2 (5.3-12.2) years. Data analysis was conducted in March 2024.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Surgical MV repair or replacement.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcome was all-cause mortality after MV surgery. Restricted cubic spline (RCS) curves visualized the association between LVEF, LV-GLS, and mortality for each sex.<\/jats:p><\/jats:sec>Results<\/jats:title>Among 1686 patients, 1088 (64.5%) were men and 598 (35.5%) were women. Women were older than men (median [IQR] age, 62 [51-70] vs 54 [45-63] years) and had higher LVEF and LV-GLS than men did. During the follow-up, 220 (13.0%) deaths occurred (117 men [10.8%]; 103 women [17.2%]). In Kaplan-Meier curves, mortality in men increased in the lowest LVEF (\u226455%) and LV-GLS (&amp;lt;19.9%) groups, whereas women exhibited an earlier increase in mortality at higher LVEF (55%-60%) and LV-GLS (19.9%-23.4%) levels. Multivariable Cox analyses showed a higher mortality risk associated with LVEF less than or equal to 55% (adjusted hazard ratio [HR], 3.48; 95% CI, 1.84-6.58; P<\/jats:italic>\u2009&amp;lt;\u2009.001) and 55%\u2009to\u200960% (adjusted HR, 2.21; 95% CI, 1.36-3.58; P<\/jats:italic>\u2009=\u2009.001) compared with LVEF greater than 60% in women, but not in men (P <\/jats:italic>for interaction by sex\u2009=\u2009.02). RCS curves showed an earlier increase in mortality risk at higher LVEF and LV-GLS levels in women. Similar trends were observed in asymptomatic patients.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cohort study of patients with severe degenerative MR, women had an earlier increase in mortality risk associated with LV systolic dysfunction, suggesting the need to consider sex-specific criteria for early surgery in asymptomatic patients.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.2420","type":"journal-article","created":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T15:56:59Z","timestamp":1743436619000},"page":"e252420","source":"Crossref","is-referenced-by-count":9,"title":["Sex-Specific Association of Left Ventricular Function With Mortality in Severe Mitral Regurgitation"],"prefix":"10.1001","volume":"8","author":[{"given":"Soongu","family":"Kwak","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South 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