Sex-Specific Differences in Ventricular Remodeling and Response After Cardiac Resynchronization Therapy

Area of Science:

• Cardiology
• Cardiac Electrophysiology
• Heart Failure Management

Background:

• Cardiac resynchronization therapy (CRT) is a key treatment for heart failure.
• While women show improved echocardiographic response to CRT, their functional response and long-term outcomes relative to men require further investigation.

Purpose of the Study:

• To compare baseline characteristics and clinical response trajectories in men and women post-CRT implantation.
• To analyze the relationship between sex, echocardiographic and functional response, and all-cause mortality after CRT.

Main Methods:

• Retrospective analysis of 592 patients undergoing CRT implantation.
• Longitudinal linear mixed effects models for cardiac response, including sex-time interactions.
• Cox regression models to assess all-cause mortality differences by gender.

Main Results:

• Women had younger age, less ischemic heart failure, shorter QRS duration, and more left bundle branch block at baseline.
• Women demonstrated greater left ventricular ejection fraction improvement starting around 1 month post-CRT.
• No significant gender differences were observed in New York Heart Association class or 6-minute walk distance response; adjusted mortality was similar between sexes.

Conclusions:

• Women are more likely to receive CRT for left bundle branch block and show superior early echocardiographic response.
• Despite echocardiographic benefits, functional response and adjusted long-term clinical outcomes after CRT are not significantly different between men and women.