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Gender in cardiac resynchronisation therapy.

Tatiana N Enina1, Vadim A Kuznetsov2, Anna M Soldatova1

  • 1Scientific researcher in Instrumental Laboratory of Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk, Russia.

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|January 26, 2019
PubMed
Summary
This summary is machine-generated.

Female patients show superior response to cardiac resynchronisation therapy (CRT), linked to greater reductions in inflammation, neurohormonal activation, and fibrosis. This highlights significant gender differences in CRT effectiveness and underlying biological pathways.

Keywords:
Cardiac ResynchronisationGender DifferencesTherapy

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Area of Science:

  • Cardiology
  • Biomedical Science
  • Heart Failure Research

Background:

  • Cardiac resynchronisation therapy (CRT) is a treatment for heart failure, but response varies.
  • Gender differences in CRT outcomes and the underlying mechanisms, including inflammation and fibrosis, require further elucidation.
  • Understanding these differences is crucial for optimizing CRT in diverse patient populations.

Purpose of the Study:

  • To investigate gender-specific influences on systemic inflammation, neurohormonal activation, and fibrosis in patients undergoing CRT for congestive heart failure (CHF).
  • To compare CRT response rates and biomarker changes between male and female CHF patients.
  • To explore potential gender-based mechanisms contributing to differential CRT efficacy.

Main Methods:

  • A comparative study of 61 men and 16 women receiving CRT for CHF.
  • Measurement of plasma biomarkers including NT-proBNP, interleukins (IL-1β, IL-6, IL-10), TNF-α, C-reactive protein, galectin-3, MMP-9, TIMP-1, and TIMP-4.
  • Classification of patients into non-responders, responders, and super-responders based on left ventricular end-systolic volume changes.

Main Results:

  • Women were more likely to have left bundle branch block (81.3% vs. 47.5%) and were more frequent super-responders (66.7% vs. 30.5%).
  • Both genders showed significant reductions in IL-6, TNF-α, NT-proBNP, and Gal-3 post-CRT.
  • Women exhibited greater percentage decreases in IL-6, TNF-α, NT-proBNP, and Gal-3 compared to men. Men showed decreased IL-10, MMP-9, and MMP-9/TIMP-4, while women had increased TIMP-1, suggesting distinct matrix metalloproteinase system activity.

Conclusions:

  • Female gender is associated with a superior response to CRT, attributed to a more pronounced reduction in neurohormonal activation, systemic inflammation, and fibrosis.
  • The observed opposite dynamics of TIMP-1 between genders suggest distinct sex-based mechanisms in the matrix metalloproteinase system's activity and its inhibitors.
  • These findings underscore the importance of considering gender in the management and understanding of CRT outcomes in heart failure patients.