Pure annular dilation as a cause of mitral regurgitation: a clinically distinct entity of female heart disease.

Pure annular dilation (PAD) is a recognized etiology of mitral regurgitation, yet few data exist to define the prognostic profile of this disorder relative to other etiologies, such as ischemia or myxomatous prolapse.A total of 535 patients undergoing mitral repair at two institutions between 1993 and 2002 was retrospectively reviewed. PAD was defined as requiring only ring annuloplasty +/- cleft repair, without evidence of prolapse, regional wall motion abnormality, or infarction.PAD was identified in 74 patients, while alternative etiologies were myxomatous prolapse (n = 290), ischemia (n = 141), and 'other' (n = 30). PAD patients were more often female (78%) than male (38%) (p < 0.001), more often hypertensive (37% versus 26%; p = 0.003), and had a left ventricular ejection fraction (LVEF) that was lower (0.41 +/- 0.12) than those in patients with prolapse (0.51 +/- 0.11; p < 0.01) but similar to values in ischemic patients (0.38 +/- 0.10). The valve size was smaller for PAD versus prolapse (ring size 24-26 mm in 71% versus 12%; p < 0.001). The unadjusted PAD prognosis was intermediate, with five-year survival being 70 +/- 8%, compared to 87 +/- 3% for prolapse and 56 +/- 5% for ischemia (p < 0.01). Survival adjusted for differences in baseline characteristics was not different among the three groups (p > 0.10).PAD is a clinically distinct etiology of mitral regurgitation associated with female gender, small valve size, a lower LVEF, and hypertension. Early, more aggressive hypertension control might improve or minimize the consequences of this predominantly female cardiac disorder.