Sex-specific difference in outcome after cardiac resynchronization therapy.
Ahmed S Beela1,2, Jürgen Duchenne1, Aniela Petrescu1
1Department of Cardiovascular Diseases, University Hospitals Leuven, University of Leuven, Herestraat 49, Leuven, Belgium.
European Heart Journal. Cardiovascular Imaging
|January 17, 2019
Summary
Women with heart failure show similar outcomes after cardiac resynchronization therapy (CRT) compared to men when baseline differences are accounted for. Sex-specific survival benefits in CRT are primarily explained by lower rates of ischemic cardiomyopathy and smaller scar burden in women.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Medical Research
Background:
- Cardiac resynchronization therapy (CRT) is a treatment for heart failure.
- Previous observations suggested better outcomes for women receiving CRT, leading to debate about sex-specific responses.
- Differences in baseline patient characteristics between sexes may influence CRT outcomes.
Purpose of the Study:
- To investigate the extent to which sex-specific differences in CRT outcomes can be attributed to baseline patient characteristics.
- To compare CRT response and survival rates between men and women after adjusting for key clinical factors.
Main Methods:
- Retrospective analysis of a multicentre registry including 1058 patients who underwent CRT.
- Echocardiography was used to assess left ventricular end-systolic volume before and after CRT.
- Baseline characteristics (e.g., New York Heart Association class, ejection fraction, QRS width, ischemic cardiomyopathy, scar burden, mechanical dyssynchrony) were analyzed.
- All-cause mortality was the primary endpoint, with a median follow-up of 59 months.
Main Results:
- Women (24% of the cohort) had lower rates of ischemic cardiomyopathy and smaller scar burden but higher rates of left bundle branch block and mechanical dyssynchrony.
- Unadjusted analysis showed better survival in women.
- After matching for baseline characteristics, survival rates between sexes became similar.
- Female sex was not an independent predictor of volumetric response or survival in multivariable analysis.
Conclusions:
- The observed better outcomes in women after CRT are largely explained by a lower prevalence of ischemic cardiomyopathy and smaller myocardial scar burden.
- When baseline characteristics are comparable, the response to CRT and long-term survival are similar between men and women.
- These findings suggest that baseline differences, rather than sex itself, account for the disparities in CRT response.
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