Rev Esp Cardiol. 2006;59(12):1335-8 1335 INTRODUCTION The etiology of mitral regurgitation is changing. Although a rheumatic etiology is still very common in developing countries, 1 Western countries are experiencing a drastic reduction in the incidence of rheumatic fever, 2 a consequence of improved sanitary conditions and the generalized use of antibiotics. However, the longer life expectancy of the citizens of these countries has led to Influence of Gender on the Etiology of Mitral Regurgitation Manuel Martínez-Sellés, a Miguel A. García-Fernández, a Mar Moreno, a Edith Larios, a José A. García-Robles, a and Ángel Pinto b a Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Madrid, Spain b Servicio de Cirugía Cardiaca, Hospital Universitario Gregorio Marañón, Madrid, España SHORT REPORT Correspondence: Dr. M. Martínez-Sellés. Servicio de Cardiología. Hospital Universitario Gregorio Marañón. Dr. Esquerdo, 46. 28007 Madrid. España. E-mail: mmselles@secardiologia.es Received October 19, 2005. Accepted for publication May 23, 2006. an increase in the number of cases of degenerative mitral regurgitation due to valve prolapse; indeed, this is commonly thought to be the main cause of organic mitral regurgitation. 3-5 Although mitral regurgitation is the second most common valve disease in Europe, 6 the etiology of this problem has recently been investigated only in surgical patients; this selection does not allow the real prevalence of the different etiologies associated with this problem to be discerned. In Spain, the prevalence of such etiologies has not been investigated at all. METHODS The data analyzed were obtained from the DECIMA (Datos Ecocardiográficos y Clínicos de la Insuficiencia Mitral Avanzada, ie, Advanced Mitral Regurgitation: Electrocardiographic and Clinical Information) registry. This is associated with a prospective study involving Our aim was to investigate the prevalence of the different causes of severe mitral regurgitation and the influence of gender on that prevalence. We performed a prospective study of 272 consecutive patients with severe mitral regurgitation that had been detected echocardiographically. Their mean age was 70.2+13.8 years, and 143 were women (52.6%). Atrial fibrillation was present in 52.9%, 72.7% presented with heart failure, and 21.0% with previous myocardial infarction. The most common etiological factor was rheumatic disease (in 26.5%), with the etiology being unclear in 32 patients (11.8%). Rheumatic disease was more frequent in women, at 35.7%, than in men, at 16.3%, whereas other etiologies were less frequent in women (P<.001). In all age groups, a rheumatic etiology was more frequent in women. Rheumatic heart disease remains the main cause of severe mitral regurgitation observed in women referred to hospitals similar to ours. Key words: Mitral regurgitation. Gender. Rheumatic disease. Influencia del sexo en la etiología de la insuficiencia mitral Para valorar la frecuencia actual de las distintas causas de insuficiencia mitral severa y la influencia del sexo en la etiología, realizamos un registro prospectivo de 272 pa- cientes consecutivos con insuficiencia mitral severa en el ecocardiograma. La edad media fue de 70,2 ± 13,8, con 143 mujeres (52,6%). El 52,9% presentaba fibrilación au- ricular, el 72,7% insuficiencia cardiaca y el 21,0%, infarto de miocardio previo. La etiología más frecuente fue la reumática (26,5%) y en 32 pacientes (11,8%) no se en- contró una clara etiología de la regurgitación mitral. La enfermedad reumática fue más frecuente en mujeres (35,7%) que en varones (16,3%), mientras que otras etio- logías fueron menos frecuentes en las mujeres (p < 0,001). Para todos los grupos de edad, la etiología reu- mática era más frecuente en mujeres. La enfermedad reumática sigue siendo la causa principal de la insuficien- cia mitral grave en las mujeres remitidas a un hospital de las características del nuestro. Palabras clave: Insuficiencia mitral. Sexo. Enfermedad reumática.