{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T09:59:38Z","timestamp":1790762378976,"version":"4.1.0"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Imaging"],"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Degenerative mitral regurgitation (DMR) due to valve prolapse predominates in men, but sex-specific differences are poorly understood due to a lack of quantitative and sex-stratified studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>The international MIDA-Q (Mitral Regurgitation International Database-Quantitative) registry enrolled 3274 men and 2331 women with greater than or equal to mild DMR prospectively quantified, comprehensively characterized, and long-term follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Women were more symptomatic despite lower effective regurgitant orifice (ERO, 27\u00b118 versus 38\u00b122 mm\n                      <jats:sup>2<\/jats:sup>\n                      , standardized mean difference 0.54;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.0001) and regurgitant volume (46\u00b126 versus 61\u00b131 mL\/beat, standardized mean difference 0.52;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.0001), even for similar mitral lesions. With increasing ERO, women showed lower regurgitant volume, higher heart rate, lower blood pressure, but left ventricular size response in women was smaller in absolute measures while larger when body surface area normalized, with higher ejection fraction and cardiac index (all\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.0001). Incidence of mitral valve surgery was similar in symptomatic women and men, but lower in asymptomatic women versus men (adjusted hazard ratio, 0.80 [0.69\u20130.94];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.008) for similar ERO, linked to smaller left ventricular diastolic absolute diameter (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.0001). Excess mortality under medical management (of severe versus mild ERO) was similar in women (adjusted hazard ratio, 1.67 [1.24\u20132.24];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.0007) and men (adjusted hazard ratio, 1.63 [1.27\u20132.09];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.0001) and versus expected survival (2.12 [1.51\u20132.98] in women and 2.27 [1.75\u20132.94] in men). However, moderate ERO (20\u201339 mm\n                      <jats:sup>2<\/jats:sup>\n                      ) was associated with significant excess mortality in women (1.47 [1.19\u20131.77] versus mild). In men, the corresponding hazard ratio did not reach statistical significance. Postoperative survival was similar in men and women.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Women with DMR present with lower ERO and regurgitant volume than men and with considerable adaptive differences to increasing DMR severity versus men. Asymptomatic women are less referred to surgery than men of similar DMR severity, linked to smaller absolute left ventricular size. Severe DMR by similar quantitative thresholds causes similar excess mortality in men and women; moderate quantitative DMR shows a trend for higher excess mortality versus expected in women than men, requiring further confirmation. These data emphasize the importance of quantitative DMR and left ventricular remodeling assessment in men and women for appropriate clinical management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circimaging.125.019952","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T09:01:11Z","timestamp":1790758871000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Sex Differences in Clinical Presentation and Outcome of Degenerative Mitral Regurgitation Quantified: The MIDA-Q Registry"],"prefix":"10.1161","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7116-5529","authenticated-orcid":true,"given":"Benjamin","family":"Essayagh","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (B.E., G.B., G.T., C.A., P.T., H.I.M., M.E.-S.)."},{"name":"Department of Echocardiography, Cardio X Clinic, Cannes, France (B.E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5660-6162","authenticated-orcid":true,"given":"Giovanni","family":"Benfari","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (B.E., G.B., G.T., C.A., P.T., H.I.M., M.E.-S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8258-8802","authenticated-orcid":true,"given":"Steele C.","family":"Butcher","sequence":"additional","affiliation":[{"name":"Leiden University Medical Center, Department of Cardiology, Leiden, the Netherlands (S.C.B.)."},{"name":"Department of Cardiology, Royal Perth Hospital, Western Australia, Australia (S.C.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4234-6504","authenticated-orcid":true,"given":"Gal","family":"Tsaban","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (B.E., G.B., G.T., C.A., P.T., H.I.M., M.E.-S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clemence","family":"Antoine","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (B.E., G.B., G.T., C.A., P.T., H.I.M., M.E.-S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4767-7073","authenticated-orcid":true,"given":"Francesco","family":"Grigioni","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Campus Bio-Medico, Rome, Italy (F.G., J.J.B., N.A.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0110-9054","authenticated-orcid":true,"given":"Thierry","family":"Le Tourneau","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Nantes, France 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