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Bivona DJ, Tallavajhala S, Abdi M, Oomen PJA, Gao X, Malhotra R, Darby A, Monfredi OJ, Mangrum JM, Mason P, Mazimba S, Salerno M, Kramer CM, Epstein FH, Holmes JW, Bilchick KC. Cardiac magnetic resonance defines mechanisms of sex-based differences in outcomes following cardiac resynchronization therapy. Front Cardiovasc Med 2022; 9:1007806. [PMID: 36186999 PMCID: PMC9521735 DOI: 10.3389/fcvm.2022.1007806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 08/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background Mechanisms of sex-based differences in outcomes following cardiac resynchronization therapy (CRT) are poorly understood. Objective To use cardiac magnetic resonance (CMR) to define mechanisms of sex-based differences in outcomes after CRT and describe distinct CMR-based phenotypes of CRT candidates based on sex and non-ischemic/ischemic cardiomyopathy type. Materials and methods In a prospective study, sex-based differences in three short-term CRT response measures [fractional change in left ventricular end-systolic volume index 6 months after CRT (LVESVI-FC), B-type natriuretic peptide (BNP) 6 months after CRT, change in peak VO2 6 months after CRT], and long-term survival were evaluated with respect to 39 baseline parameters from CMR, exercise testing, laboratory testing, electrocardiograms, comorbid conditions, and other sources. CMR was also used to quantify the degree of left-ventricular mechanical dyssynchrony by deriving the circumferential uniformity ratio estimate (CURE-SVD) parameter from displacement encoding with stimulated echoes (DENSE) strain imaging. Statistical methods included multivariable linear regression with evaluation of interaction effects associated with sex and cardiomyopathy type (ischemic and non-ischemic cardiomyopathy) and survival analysis. Results Among 200 patients, the 54 female patients (27%) pre-CRT had a smaller CMR-based LVEDVI (p = 0.04), more mechanical dyssynchrony based on the validated CMR CURE-SVD parameter (p = 0.04), a lower frequency of both late gadolinium enhancement (LGE) and ischemic cardiomyopathy (p < 0.0001), a greater RVEF (p = 0.02), and a greater frequency of LBBB (p = 0.01). After categorization of patients into four groups based on cardiomyopathy type (ischemic/non-ischemic cardiomyopathy) and sex, female patients with non-ischemic cardiomyopathy had the lowest CURE-SVD (p = 0.003), the lowest pre-CRT BNP levels (p = 0.01), the lowest post-CRT BNP levels (p = 0.05), and the most favorable LVESVI-FC (p = 0.001). Overall, female patients had better 3-year survival before adjustment for cardiomyopathy type (p = 0.007, HR = 0.45) and after adjustment for cardiomyopathy type (p = 0.009, HR = 0.67). Conclusion CMR identifies distinct phenotypes of female CRT patients with non-ischemic and ischemic cardiomyopathy relative to male patients stratified by cardiomyopathy type. The more favorable short-term response and long-term survival outcomes in female heart failure patients with CRT were associated with lower indexed CMR-based LV volumes, decreased presence of scar associated with prior myocardial infarction and ICM, and greater CMR-based dyssynchrony with the CURE-SVD.
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Affiliation(s)
- Derek J. Bivona
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
| | - Srikar Tallavajhala
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
| | - Mohamad Abdi
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, United States
| | - Pim J. A. Oomen
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, United States
| | - Xu Gao
- Department of Medicine, Northwestern University, Chicago, IL, United States
| | - Rohit Malhotra
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
| | - Andrew Darby
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
| | - Oliver J. Monfredi
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
| | - J. Michael Mangrum
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
| | - Pamela Mason
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
| | - Sula Mazimba
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
| | - Michael Salerno
- Department of Medicine and Radiology, Stanford University, Palo Alto, CA, United States
| | - Christopher M. Kramer
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
| | - Frederick H. Epstein
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, United States
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, United States
| | - Jeffrey W. Holmes
- Department of Medicine, Surgery, and Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Kenneth C. Bilchick
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
- *Correspondence: Kenneth C. Bilchick,
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Varrias D, De La Hoz MA, Zhao M, Pujol M, Orencole M, Venkata VS, Zordok MA, Luong K, Rana F, Lau E, Ibrahim N, Newton-Cheh C, Heist K, Singh J, Das S. Sex-Specific Differences in Ventricular Remodeling and Response After Cardiac Resynchronization Therapy. Am J Cardiol 2022; 174:68-75. [PMID: 35473782 DOI: 10.1016/j.amjcard.2022.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/10/2022] [Accepted: 03/15/2022] [Indexed: 01/18/2023]
Abstract
In this study, we investigated the baseline characteristics and "trajectories" of clinical response in men and women after cardiac resynchronization therapy (CRT) implantation. Although women enjoy improved echocardiographic response after CRT compared with men, the kinetics of this response and its relation to functional performance and outcomes are less clear. We identified 592 patients who underwent CRT implantation at our center between 2004 and 2017 and were serially followed in a multidisciplinary clinic. Longitudinal linear mixed effects regression for cardiac response was specified, including interaction terms between time after CRT and sex , and Cox regression models were used to assess differences in all-cause mortality by gender after CRT. Women in our cohort were younger than men, had less frequent ischemic etiology of heart failure (24% vs 60% in men), a shorter QRS (151 vs 161 ms) and more frequent left bundle branch block (77% vs 52%) at baseline. Women had a greater improvement in left ventricular ejection fraction that was evident starting at approximately 1-month after CRT. We did not observe effect modification by gender in New York Heart Association class or 6-minute walk distance after CRT. Although women had improved mortality after CRT, after adjustment for potential confounders, gender was not associated with mortality after CRT. In conclusion, women were more likely to have CRT implantation for left bundle branch block and exhibited improved echocardiographic but not functional response within the first year after CRT. Clinical outcomes after CRT were not associated with gender in adjusted analysis.
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Association between electrical and mechanical remodeling after cardiac resynchronization therapy: systematic review and meta-analysis of observational studies. Heart Fail Rev 2022; 27:2165-2176. [DOI: 10.1007/s10741-022-10234-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 11/26/2022]
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Leyva F, Qiu T, Zegard A, McNulty D, Evison F, Ray D, Gasparini M. Sex-Specific Differences in Survival and Heart Failure Hospitalization After Cardiac Resynchronization Therapy With or Without Defibrillation. J Am Heart Assoc 2019; 8:e013485. [PMID: 31718445 PMCID: PMC6915284 DOI: 10.1161/jaha.119.013485] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Women are underrepresented in cardiac resynchronization therapy (CRT) trials. Some studies suggest that women fare better than men after CRT. We sought to explore clinical outcomes in women and men undergoing CRT‐defibrillation or CRT‐pacing in real‐world clinical practice. Methods and Results A national database (Hospital Episode Statistics for England) was used to quantify clinical outcomes in 43 730 patients (women: 10 890 [24.9%]; men: 32 840 [75.1%]) undergoing CRT over 7.6 years, (median follow‐up 2.2 years, interquartile range, 1–4 years). In analysis of the total population, the primary end point of total mortality (adjusted hazard ratio [aHR], 0.73; 95% CI, 0.69–0.76) and the secondary end point of total mortality or heart failure hospitalization (aHR, 0.79, 95% CI 0.75–0.82) were lower in women, independent of known confounders. Total mortality (aHR, 0.73; 95% CI, 0.70–0.76) and total mortality or heart failure hospitalization (aHR, 0.79; 95% CI, 0.75–0.82) were lower for CRT‐defibrillation than for CRT‐pacing. In analyses of patients with (aHR, 0.89; 95% CI, 0.80–0.98) or without (aHR, 0.70; 95% CI, 0.66–0.73) a myocardial infarction, women had a lower total mortality. In sex‐specific analyses, total mortality was lower after CRT‐defibrillation in women (aHR, 0.83; P=0.013) and men (aHR, 0.69; P<0.001). Conclusions Compared with men, women lived longer and were less likely to be hospitalized for heart failure after CRT. In both sexes, CRT‐defibrillation was superior to CRT‐pacing with respect to survival and heart failure hospitalization. The longest survival after CRT was observed in women without a history of myocardial infarction.
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Affiliation(s)
- Francisco Leyva
- Aston Medical Research Institute Aston Medical School Aston University Birmingham United Kingdom
| | - Tian Qiu
- Quality and Outcomes Research Unit Queen Elizabeth Hospital Birmingham United Kingdom
| | - Abbasin Zegard
- Aston Medical Research Institute Aston Medical School Aston University Birmingham United Kingdom
| | - David McNulty
- Quality and Outcomes Research Unit Queen Elizabeth Hospital Birmingham United Kingdom
| | - Felicity Evison
- Quality and Outcomes Research Unit Queen Elizabeth Hospital Birmingham United Kingdom
| | - Daniel Ray
- NHS Digital and Farr Institute London United Kingdom
| | - Maurizio Gasparini
- Electrophysiology and Pacing Unit Humanitas Research Hospital IRCCS Rozzano-Milano Italy
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Enina TN, Kuznetsov VA, Soldatova AM, Petelina TI, Krinochkin DV, Rychkov AY, Nochrina OY. Gender in cardiac resynchronisation therapy. J Cardiovasc Thorac Res 2018; 10:197-202. [PMID: 30680077 PMCID: PMC6335983 DOI: 10.15171/jcvtr.2018.34] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 05/11/2018] [Indexed: 12/27/2022] Open
Abstract
Introduction:
Gender differences in cardiac resynchronisation therapy (CRT) response are
not clear enough. This study aimed to assess gender influence on systemic inflammation,
neurohormonal activation, fibrosis in patients with congestive heart failure (CHF) and CRT.
Methods: We compared group I (61 men) and group II (16 women) of patients undergoing
CRT. Plasma levels of Nt-proBNP, interleukin (IL)-1β, IL-6, IL-10, tumor necrosis factor alpha
(TNF-α), C-reactive protein, galectin-3 (Gal-3), metalloproteinase-9 (MMP-9), tissue inhibitors
of metalloproteinase 1 and 4 (TIMP-1, TIMP-4), ratio MMP-9/TIMP-1, MMP-9/TIMP-4 were
measured. According to dynamics of left ventricular end-systolic volume patients were classified
into non-responders, responders, super-responders.
Results: Women more likely had left bundle branch block (81.3 vs 47.5%, P = 0.016), were more
super-responders (66.7 vs 30.5%). Both groups showed decrease of IL-6 (P < 0.05), TNF-α
(P < 0.001; P < 0.05), NT-proBNP (P = 0.001; P < 0.05), Gal-3 (P < 0.05). In women there was
decrease of IL-6 by 44.4 vs 23.5% in men (PP = 0.029), TNF-α by 41.4 vs 30.9%, NT-proBNP by 73.3
vs 46% (P = 0.002), Gal-3 by 82.3 vs 64.9% (P < 0.05). Group I also showed decrease of IL-10 by
34.2% (P < 0.05). Group dynamics of TIMP-1 was opposite: men showed tendency to reduction of
TIMP-1 (P = 0.054), women showed increase of TIMP-1 (P < 0.05). Besides, men showed decrease
of MMP-9 (P < 0.05) and ratio MMP-9/TIMP-4 (P < 0.05).
Conclusion: The best response to CRT is associated with female gender explained by greater
decrease of neurohormonal activation, systemic inflammation and fibrosis. The revealed opposite
dynamics of TIMP-1 in the groups can demonstrate the existence of gender features of matrix
metalloproteinase system activity and their tissue inhibitors.
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Affiliation(s)
- Tatiana N Enina
- Scientific researcher in Instrumental Laboratory of Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk, Russia
| | - Vadim A Kuznetsov
- Director of Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk, Russia
| | - Anna M Soldatova
- Scientific researcher in Instrumental Laboratory of Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk, Russia
| | - Tatiana I Petelina
- Scientific researcher in Instrumental Laboratory of Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk, Russia
| | - Dmitriy V Krinochkin
- Scientific researcher in Instrumental Laboratory of Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk, Russia
| | - Alexander Yu Rychkov
- Scientific researcher in Instrumental Laboratory of Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk, Russia
| | - Olga Yu Nochrina
- Scientific researcher in Instrumental Laboratory of Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk, Russia
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Diemberger I, Marazzi R, Casella M, Vassanelli F, Galimberti P, Luzi M, Borrelli A, Soldati E, Golzio PG, Fumagalli S, Francia P, Padeletti L, Botto G, Boriani G. The effects of gender on electrical therapies for the heart: procedural considerations, results and complications: A report from the XII Congress of the Italian Association on Arrhythmology and Cardiostimulation (AIAC). Europace 2018; 19:1911-1921. [PMID: 28520959 DOI: 10.1093/europace/eux034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 05/02/2017] [Indexed: 12/28/2022] Open
Abstract
Use of cardiac implantable devices and catheter ablation is steadily increasing in Western countries following the positive results of clinical trials. Despite the advances in scientific knowledge, tools development, and techniques improvement we still have some grey area in the field of electrical therapies for the heart. In particular, several reports highlighted differences both in medical behaviour and procedural outcomes between female and male candidates. Women are referred later for catheter ablation of supraventricular arrhythmias, especially atrial fibrillation, leading to suboptimal results. On the opposite females present greater response to cardiac resynchronization, while the benefit of implantable defibrillator in primary prevention seems to be less pronounced. Differences on aetiology, clinical profile, and development of myocardial scarring are the more plausible causes. This review will discuss all these aspects together with gender-related differences in terms of acute/late complications. We will also provide useful hints on plausible mechanisms and practical procedural aspects.
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Affiliation(s)
- Igor Diemberger
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Via Massarenti n. 9, 40138, Bologna, Italy
| | - Raffaella Marazzi
- Department of Heart and Vessels, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy
| | - Michela Casella
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Francesca Vassanelli
- Chair and Unit of Cardiology, University of Brescia, Spedali Civili Hospital, Brescia, Italy
| | - Paola Galimberti
- Electrophysiology and Pacing Unit, Humanitas Clinical and Research Center, Rozzano-Milano, Italy
| | - Mario Luzi
- Cardiology Clinic, Marche Polytechnic University, Ancona, Italy
| | | | - Ezio Soldati
- Cardiac Thoracic and Vascular Department, University Hospital of Pisa, Italy
| | - Pier Giorgio Golzio
- Division of Cardiology, Department of Internal Medicine, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Stefano Fumagalli
- Intensive Care Unit, Geriatric Cardiology and Medicine Division, Experimental and Clinical Medicine Department, University of Florence and AOU Careggi, Florence, Italy
| | - Pietro Francia
- Cardiac Electrophysiology Unit, Cardiology, St. Andrea Hospital, University "Sapienza", Rome, Italy
| | - Luigi Padeletti
- University of Florence, Florence, Italy IRCCS MultiMedica, Sesto San Giovanni, Italy
| | - Gianluca Botto
- EP Unit, Department of Medicine, Sant'Anna Hospital, Como, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
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The gender difference of utilization of cardiac implantable electronic device in China: data from Arrhythmia Interventional Therapy Data Registry. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2018; 15:310-314. [PMID: 29915621 PMCID: PMC5997612 DOI: 10.11909/j.issn.1671-5411.2018.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Cardiac implantable electronic devices (CIEDs) greatly improve survival and life quality of patients. However, there are gender differences regarding both the utilization and benefit of these devices. In this prospective CIED registry, we aim to appraise the gender differences in CIED utilization in China. Methods Twenty centers from 14 provinces in China were included in our registry study. All patients who underwent a CIED implantation in these twenty centers between Jan 2015 and Dec 2016 were included. Results A total of 8570 patients were enrolled in the baseline cohort, including 7203 pacemaker, 664 implantable cardiac defibrillators (ICD) implants and 703 cardiac resynchronization therapy device (CRT/D). Totally, 4117 (48.0%) CIED patients were female, and more than 59% pacemaker patients were female, but women account only one third of ICD or CRT/D implantation in this registry. There were significant differences between genders at pacemaker and ICD indications. Female was more likely received a pacemaker due to sick sinus syndrome (SSS) (63.9% vs. 51.0%, P < 0.001). Female patients receiving an ICD were more likely due to cardiac ion channel disease (29.2% vs. 4.2%, P < 0.001). The percentage of utilization of dual-chamber pacemaker in female patients was significantly higher than male (85.3% vs. 81.1%, P < 0.001). But male patients were more likely received a cardiac resynchronization therapy devices with defibrillator than female (56.5% vs. 41.9%, P = 0.001). In pacemaker patient, male was more likely to have structure heart disease (31.3% vs. 28.0%, P = 0.002). In ICD patient, male patients were more likely to have ischemic heart disease (48.2% vs. 29.2%, P < 0.001). The mean age of women at the time of CRT/D implantation was older than men (P = 0.014). Nonischemic cardiomyopathy (70.9%) was the most common etiology in the patients who underwent the treatment of CRT/D, no matter male or female. Conclusions In real-world setting, female do have different epidemiology, pathophysiology and clinical presentation of many cardiac rhythm disorders when compared with male, and all these factors may affect the utilization of CIED implantation. But it also possibility that cultural and socioeconomic features may play a role in this apparent discrimination.
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Gallego Muñoz C, Saldarriaga CI, Cañas Arenas EM, Delgado Gómez C, González Berrío C. Evaluación de la respuesta a la terapia de resincronización cardíaca en un grupo de pacientes que asisten a un programa de falla cardíaca. REVISTA COLOMBIANA DE CARDIOLOGÍA 2017. [DOI: 10.1016/j.rccar.2017.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Abstract
Heart failure is an important cause of morbidity and mortality in women, and they tend to develop it at an older age compared to men. Heart failure with preserved ejection fraction is more common in women than in men and accounts for at least half the cases of heart failure in women. When comparing men and women who have heart failure and a low left ventricular ejection fraction, the women are more symptomatic and have a similarly poor outcome. Overall recommendations for guideline-directed medical therapies show no differences in treatment approaches between men and women. Overall, women are generally underrepresented in clinical trials for heart failure. Further studies are needed to shed light into different mechanisms, causes, and targeted therapies of heart failure in women.
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Affiliation(s)
- Biykem Bozkurt
- WINTERS CENTER FOR HEART FAILURE RESEARCH, CARDIOVASCULAR RESEARCH INSTITUTE, BAYLOR COLLEGE OF MEDICINE, HOUSTON, TEXAS
| | - Shaden Khalaf
- WINTERS CENTER FOR HEART FAILURE RESEARCH, CARDIOVASCULAR RESEARCH INSTITUTE, BAYLOR COLLEGE OF MEDICINE, HOUSTON, TEXAS
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Han Z, Chen Z, Lan R, Di W, Li X, Yu H, Ji W, Zhang X, Xu B, Xu W. Sex-specific mortality differences in heart failure patients with ischemia receiving cardiac resynchronization therapy. PLoS One 2017; 12:e0180513. [PMID: 28683134 PMCID: PMC5500352 DOI: 10.1371/journal.pone.0180513] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 06/18/2017] [Indexed: 01/01/2023] Open
Abstract
Background Recent studies have reported prognosis differences between male and female heart failure patients following cardiac resynchronization therapy (CRT). However, the potential clinical factors that underpin these differences remain to be elucidated. Methods A meta-analysis was performed to investigate the factors that characterize sex-specific differences following CRT. This analysis involved searching the Medline (Pubmed source) and Embase databases in the period from January 1980 to September 2016. Results Fifty-eight studies involving 33445 patients (23.08% of whom were women) were analyzed as part of this study. Only patients receiving CRT with follow-up greater than six months were included in our analysis. Compared with males, females exhibited a reduction of 33% (hazard ratio, 0.67; 95% confidence interval, 0.62–0.73; P < 0.0001) and 42% (hazard ratio, 0.58; 95% confidence interval, 0.46–0.74; P = 0.003) in all-cause mortality and heart failure hospitalization or heart failure, respectively. Following a stratified analysis of all-cause mortality, we observed that ischemic causes (p = 0.03) were likely to account for most of the sex-specific differences in relation to CRT. Conclusion These data suggest that women have a reduced risk of all-cause mortality and heart failure hospitalization or heart failure following CRT. Based on the results from the stratified analysis, we observed more optimal outcomes for females with ischemic heart disease. Thus, ischemia are likely to play a role in sex-related differences associated with CRT in heart failure patients. Further studies are required to determine other indications and the potential mechanisms that might be associated with sex-specific CRT outcomes.
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Affiliation(s)
- Zhonglin Han
- Department of Cardiology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, China
| | - Zheng Chen
- Department of Cardiology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, China
| | - Rongfang Lan
- Department of Cardiology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, China
| | - Wencheng Di
- Department of Cardiology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, China
| | - Xiaohong Li
- Department of Cardiology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, China
| | - Hongsong Yu
- Department of Cardiology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, China
| | - Wenqing Ji
- Department of Cardiology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, China
| | - Xinlin Zhang
- Department of Cardiology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, China
| | - Biao Xu
- Department of Cardiology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, China
| | - Wei Xu
- Department of Cardiology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, China
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Yin FH, Fan CL, Guo YY, Zhu H, Wang ZL. The impact of gender difference on clinical and echocardiographic outcomes in patients with heart failure after cardiac resynchronization therapy: A systematic review and meta-analysis. PLoS One 2017; 12:e0176248. [PMID: 28453545 PMCID: PMC5409183 DOI: 10.1371/journal.pone.0176248] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 04/07/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Cardiac resynchronization therapy(CRT) has been recommended as a standard treatment for patients with advanced heart failure. However, some studies have reported different clinical and echocardiographic outcomes between male and female patients who received CRT. This Meta-analysis is to determine whether gender difference has any significant impact on clinical and echocardiographic outcomes in patients with heart failure after CRT. METHODS AND RESULTS PubMed, Embase, and the Cochrane library database were searched. A total of 149,259 patients in 11 studies were identified. Our analysis demonstrated that women showed lower all-cause mortality than men after CRT (odds ratio[OR] 0.50, 95% confidence interval [CI] 0.36 to 0.70). No significant difference was observed in the increment of New York Heart Association (NYHA) functional class(standard mean difference[SMD] -0.07,95% CI -0.15 to 0.01), 6-minitue walk distance (6-MWD) (SMD -0.05, 95% CI -0.07 to 0.17), and quality of life (QoL) (SMD -0.10, 95% CI -0.23 to 0.03). With respect to the echocardiographic parameters, women exhibited statistically significant improvement in left ventricular ejection fraction (LVEF) (SMD 0.25,95% CI 0.07 to 0.43), and decrement of left ventricular end diastolic diameter (LVEDD) (SMD -0.27, 95% CI -0.39 to -0.25) as compared with men. No significant difference was observed in left ventricular end diastolic volume (LVEDV) (SMD -0.08, 95% CI -0.28 to 0.08) and left ventricular end systolic volume (LVESV) (SMD -0.16, 95% CI -0.40 to 0.09) between men and women. CONCLUSION Women seem to obtain greater benefits from CRT both in clinical and echocardiographic outcomes compared with men. But as this gender superiority could be observed only during long-term follow-up periods, further studies are needed to elucidate exact reasons for this phenomenon.
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Affiliation(s)
- Fa-Hui Yin
- The First Medical Clinical College of Lanzhou University, Lanzhou, Gansu, China
| | - Chun-Lei Fan
- The First Medical Clinical College of Lanzhou University, Lanzhou, Gansu, China
| | - Ya-Ya Guo
- The First Medical Clinical College of Lanzhou University, Lanzhou, Gansu, China
| | - Hai Zhu
- Department of Cardiology, Gansu Province People’s Hospital, Lanzhou, Gansu, China
| | - Zhi-Lu Wang
- Department of Cardiology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
- * E-mail:
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Gage RM, Curtin AE, Burns KV, Ghosh S, Gillberg JM, Bank AJ. Changes in electrical dyssynchrony by body surface mapping predict left ventricular remodeling in patients with cardiac resynchronization therapy. Heart Rhythm 2017; 14:392-399. [DOI: 10.1016/j.hrthm.2016.11.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Indexed: 10/20/2022]
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Gomes M, Hatfield L, Normand SL. Handling incomplete correlated continuous and binary outcomes in meta-analysis of individual participant data. Stat Med 2016; 35:3676-89. [PMID: 27090498 PMCID: PMC4982066 DOI: 10.1002/sim.6969] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 03/15/2016] [Accepted: 03/24/2016] [Indexed: 01/25/2023]
Abstract
Meta‐analysis of individual participant data (IPD) is increasingly utilised to improve the estimation of treatment effects, particularly among different participant subgroups. An important concern in IPD meta‐analysis relates to partially or completely missing outcomes for some studies, a problem exacerbated when interest is on multiple discrete and continuous outcomes. When leveraging information from incomplete correlated outcomes across studies, the fully observed outcomes may provide important information about the incompleteness of the other outcomes. In this paper, we compare two models for handling incomplete continuous and binary outcomes in IPD meta‐analysis: a joint hierarchical model and a sequence of full conditional mixed models. We illustrate how these approaches incorporate the correlation across the multiple outcomes and the between‐study heterogeneity when addressing the missing data. Simulations characterise the performance of the methods across a range of scenarios which differ according to the proportion and type of missingness, strength of correlation between outcomes and the number of studies. The joint model provided confidence interval coverage consistently closer to nominal levels and lower mean squared error compared with the fully conditional approach across the scenarios considered. Methods are illustrated in a meta‐analysis of randomised controlled trials comparing the effectiveness of implantable cardioverter‐defibrillator devices alone to implantable cardioverter‐defibrillator combined with cardiac resynchronisation therapy for treating patients with chronic heart failure. © 2016 The Authors. Statistics in Medicine Published by John Wiley & Sons Ltd.
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Affiliation(s)
- Manuel Gomes
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, U.K
| | - Laura Hatfield
- Department of Health Care Policy, Harvard Medical School, Boston, 02115, MA, U.S.A
| | - Sharon-Lise Normand
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, 02115, MA, U.S.A
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14
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Harvey RE, Coffman KE, Miller VM. Women-specific factors to consider in risk, diagnosis and treatment of cardiovascular disease. ACTA ACUST UNITED AC 2015; 11:239-257. [PMID: 25776297 DOI: 10.2217/whe.14.64] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In the era of individualized medicine, gaps in knowledge remain about sex-specific risk factors, diagnostic and treatment options that might reduce mortality from cardiovascular disease (CVD) and improve outcomes for both women and men. In this review, contributions of biological mechanisms involving the sex chromosomes and the sex hormones on the cardiovascular system will be discussed in relationship to the female-specific risk factors for CVD: hypertensive disorders of pregnancy, menopause and use of hormonal therapies for contraception and menopausal symptoms. Additionally, sex-specific factors to consider in the differential diagnosis and treatment of four prevalent CVDs (hypertension, stroke, coronary artery disease and congestive heart failure) will be reviewed with emphasis on areas where additional research is needed.
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Affiliation(s)
- Ronée E Harvey
- Department of Physiology & Biomedical, Engineering, Medical Sciences 4-20, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Kirsten E Coffman
- Department of Physiology & Biomedical, Engineering, Medical Sciences 4-20, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Virginia M Miller
- Department of Physiology & Biomedical, Engineering, Medical Sciences 4-20, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA.,Department of Surgery, Medical Sciences, 4-20, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
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15
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Zusterzeel R, Selzman KA, Sanders WE, O’Callaghan KM, Caños DA, Vernooy K, Prinzen FW, Gorgels APM, Strauss DG. Toward Sex-Specific Guidelines for Cardiac Resynchronization Therapy? J Cardiovasc Transl Res 2015; 9:12-22. [DOI: 10.1007/s12265-015-9663-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 11/30/2015] [Indexed: 11/28/2022]
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16
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Abstract
Cardiac resynchronisation therapy (CRT) is an effective intervention for appropriately selected patients with heart failure, but exactly how it works is uncertain. Recent data suggest that much, or perhaps most, of the benefits of CRT are not delivered by re-coordinating left ventricular dyssynchrony. Atrio-ventricular resynchronization, reduction in mitral regurgitation and prevention of bradycardia are other potential mechanisms of benefit that will vary from one patient to the next and over time. Because there is no single therapeutic target, it is unlikely that any single measure will accurately predict benefit. The only clinical characteristic that appears to be a useful predictor of the benefits of CRT is a QRS duration of >140 ms. Many new approaches are being developed to try to improve the effectiveness of and extend the indications for CRT. These include smart pacing algorithms, better pacing-site targeting, new sensors, multipoint pacing, remote device monitoring and leadless endocardial pacing. Whether CRT is effective in patients with atrial fibrillation or whether adding a defibrillator function to CRT improves prognosis awaits further evidence.
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17
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Abstract
PURPOSE OF REVIEW Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in patients with mild-to-severe heart failure. However, up to 40% of CRT recipients are nonresponders. This review addresses important aspects with regard to the identification and management of CRT nonresponders. RECENT FINDINGS Mid-term clinical or echocardiographic nonresponse is associated with worse clinical outcomes during the extended follow-up. A number of predictors are indicative of CRT response, which include patient characteristics, electrical determinants, and imaging techniques from preimplant to postimplant period, and can be grouped as modifiable and nonmodifiable contributors to treatment response. Advanced age, male sex, ischemic cause, end-stage heart failure, inadequate electrical delay, and absence of mechanical dyssynchrony are regarded as unfavorable but nonmodifiable factors, for which considering underutilization of CRT by refining patient selection is reasonable. On the contrary, more efforts should be made to optimize patient management by correcting those modifiable factors, such as suboptimal medical therapy, uncontrolled atrial fibrillation, left ventricular lead dislodgement or inappropriate location, loss of biventricular capture, and lack of device optimization. SUMMARY Proper management and careful selection of CRT recipients will transform a proportion of treatment nonresponders into responders, which is vital to improve patients' outcome.
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18
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Comparative Effectiveness of Cardiac Resynchronization Therapy Defibrillators Versus Standard Implantable Defibrillators in Medicare Patients. Am J Cardiol 2015; 116:79-84. [PMID: 25933736 DOI: 10.1016/j.amjcard.2015.03.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 03/26/2015] [Accepted: 03/26/2015] [Indexed: 11/21/2022]
Abstract
Previous analyses have shown that there is lower mortality with cardiac resynchronization therapy defibrillators (CRT-D) in patients with left bundle branch block (LBBB) but demonstrated mixed results in patients without LBBB. We evaluated the comparative effectiveness of CRT-D versus standard implantable defibrillators (ICDs) separately in patients with LBBB and right bundle branch block (RBBB) using Medicare claims data. Medicare records from CRT-D and ICD recipients from 2002 to 2009 that were followed up for up to 48 months were analyzed. We used propensity scores to match patients with ICD to those with CRT-D. In LBBB, 1:1 matching with replacement resulted in 54,218 patients with CRT-D and 20,763 with ICD, and in RBBB, 1:1 matching resulted in 7,298 patients with CRT-D and 7,298 with ICD. In LBBB, CRT-D had a 12% lower risk of heart failure hospitalization or death (hazard ratio [HR] 0.88, 95% confidence interval 0.86 to 0.90) and 5% lower death risk (HR 0.95, 0.92 to 0.97) compared with ICD. In RBBB, CRT-D had a 15% higher risk of heart failure hospitalization or death (HR 1.15, 1.10 to 1.20) and 13% higher death risk (HR 1.13, 1.07 to 1.18). Sensitivity analysis revealed that accounting for covariates not captured in the Medicare database may lead to increased benefit with CRT-D in LBBB and no difference in RBBB. In conclusion, in a large Medicare population, CRT-D was associated with lower mortality in LBBB but higher mortality in RBBB. The absence of certain covariates, in particular those that determine treatment selection, may affect the results of comparative effectiveness studies using claims data.
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19
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Mehta NK, Abraham WT, Maytin M. ICD and CRT use in ischemic heart disease in women. Curr Atheroscler Rep 2015; 17:512. [PMID: 25921310 DOI: 10.1007/s11883-015-0512-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Although the role of implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT) in improving outcomes in ischemic cardiomyopathy (ICM) has been described, the data regarding gender-based survival outcomes are limited. There is a higher preponderance of non-ischemic cardiomyopathy (NICM) in women, and most of the ICM literature is derived from sub-study analysis. This review summarizes the current body of literature on prognosis, pathophysiology, and the present clinical practice for device implantation in women with ICM.
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Affiliation(s)
- Nishaki Kiran Mehta
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43220, USA,
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20
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Reitan C, Chaudhry U, Bakos Z, Brandt J, Wang L, Platonov PG, Borgquist R. Long-Term Results of Cardiac Resynchronization Therapy: A Comparison between CRT-Pacemakers versus Primary Prophylactic CRT-Defibrillators. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:758-67. [PMID: 25788040 DOI: 10.1111/pace.12631] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 02/02/2015] [Accepted: 03/12/2015] [Indexed: 01/23/2023]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) with or without a defibrillator has a positive effect on mortality and morbidity for patients with heart failure. However, comparisons between CRT-defibrillators (CRT-D) and CRT-pacemakers (CRT-P) are relatively scarce outside the clinical trial setting. This study aimed to assess baseline characteristics in relation to long-term prognosis in patients treated with CRT, and to investigate the potential benefit of CRT-D versus CRT-P. METHODS Data were retrospectively collected from the medical records of all consecutive patients treated with CRT-P or primary prophylactic CRT-D at a large tertiary care center between 1999 and 2012. Predictors of mortality were investigated, and time-dependent analysis was performed with all-cause mortality as the primary end point. RESULTS A total of 705 patients were included (69.6 ± 10 years, 78% New York Heart Association classes III-IV, left ventricular ejection fraction median 25%, 16% female, 36% CRT-D). The patients were followed for a median of 59 months. Annual mortality differed between CRT-D primary prophylactic and CRT-P groups (5.3% and 11.8%, respectively), but when adjusted for covariates, CRT-D treatment (compared to CRT-P) was not associated with better long-term survival. Independent predictors of survival were: age, use of loop diuretics, hemoglobin levels, and use of renin angiotensin aldosterone system blockers. CONCLUSIONS In CRT treatment outside of the clinical trial setting, CRT-D treatment was not an independent predictor of long-term survival. Future research should focus on correct selection of the patients who receive enough benefit of an added defibrillator to justify CRT-D implantation instead of CRT-P treatment only.
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Affiliation(s)
- Christian Reitan
- Lund University, Arrhythmia Clinic, Skane University Hospital, Lund, Sweden
| | - Uzma Chaudhry
- Lund University, Arrhythmia Clinic, Skane University Hospital, Lund, Sweden
| | - Zoltan Bakos
- Lund University, Arrhythmia Clinic, Skane University Hospital, Lund, Sweden
| | - Johan Brandt
- Lund University, Arrhythmia Clinic, Skane University Hospital, Lund, Sweden
| | - Lingwei Wang
- Lund University, Arrhythmia Clinic, Skane University Hospital, Lund, Sweden
| | - Pyotr G Platonov
- Lund University, Arrhythmia Clinic, Skane University Hospital, Lund, Sweden
| | - Rasmus Borgquist
- Lund University, Arrhythmia Clinic, Skane University Hospital, Lund, Sweden
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21
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Herz ND, Engeda J, Zusterzeel R, Sanders WE, O'Callaghan KM, Strauss DG, Jacobs SB, Selzman KA, Piña IL, Caños DA. Sex differences in device therapy for heart failure: utilization, outcomes, and adverse events. J Womens Health (Larchmt) 2015; 24:261-71. [PMID: 25793483 DOI: 10.1089/jwh.2014.4980] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Multiple studies of heart failure patients demonstrated significant improvement in exercise capacity, quality of life, cardiac left ventricular function, and survival from cardiac resynchronization therapy (CRT), but the underenrollment of women in these studies is notable. Etiological and pathophysiological differences may result in different outcomes in response to this treatment by sex. The observed disproportionate representation of women suggests that many women with heart failure either do not meet current clinical criteria to receive CRT in trials or are not properly recruited and maintained in these studies. METHODS We performed a systematic literature review through May 2014 of clinical trials and registries of CRT use that stratified outcomes by sex or reported percent women included. One-hundred eighty-three studies contained sex-specific information. RESULTS Ninety percent of the studies evaluated included ≤ 35% women. Fifty-six articles included effectiveness data that reported response with regard to specific outcome parameters. When compared with men, women exhibited more dramatic improvement in specific parameters. In the studies reporting hazard ratios for hospitalization or death, women generally had greater benefit from CRT. CONCLUSIONS Our review confirms women are markedly underrepresented in CRT trials, and when a CRT device is implanted, women have a therapeutic response that is equivalent to or better than in men, while there is no difference in adverse events reported by sex.
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Affiliation(s)
- Naomi D Herz
- Center for Devices and Radiological Health, United States Food and Drug Administration , Silver Spring, Maryland
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22
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Cipriani M, Ammirati E, Landolina M, Oliva F, Ghio S, Rordorf R, Lunati M. Cumulative analysis on 4802 patients confirming that women benefit more than men from cardiac resynchronization therapy. Int J Cardiol 2015; 182:454-6. [DOI: 10.1016/j.ijcard.2015.01.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 01/07/2015] [Accepted: 01/09/2015] [Indexed: 11/27/2022]
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23
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Zusterzeel R, Spatz ES, Curtis JP, Sanders WE, Selzman KA, Piña IL, Bao H, Ponirakis A, Varosy PD, Masoudi FA, Caños DA, Strauss DG. Cardiac resynchronization therapy in women versus men: observational comparative effectiveness study from the National Cardiovascular Data Registry. Circ Cardiovasc Qual Outcomes 2015; 8:S4-11. [PMID: 25714821 DOI: 10.1161/circoutcomes.114.001548] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Women have been under-represented in trials of cardiac resynchronization therapy-defibrillators (CRT-D). Previous studies suggest that women benefit from CRT-D at shorter QRS duration than men and that there may be no benefit of CRT-D in patients without left bundle branch block (LBBB) regardless of patient sex. METHODS AND RESULTS We compared sex-specific death risk in 75 079 patients with New York Heart Association class III or IV heart failure, reduced left ventricular ejection fraction, and prolonged QRS duration (≥120 ms) receiving either CRT-D or implantable cardioverter defibrillator in subgroups according to QRS morphology and 10-ms increments in QRS duration. We applied propensity score weighting to control for differences between treatments. Among patients with LBBB, women receiving CRT-D had a lower relative death risk than those receiving an implantable cardioverter-defibrillator (absolute difference, 11%; hazard ratio=0.74 [95% confidence interval, 0.68-0.81]). In men, the lower mortality with CRT-D versus implantable cardioverter defibrillator was less pronounced (absolute difference, 9%; hazard ratio=0.84 [0.79-0.89]; sex×device interaction P=0.025). In those without LBBB, the mortality difference was modest and did not differ between women and men (absolute difference, 3%; hazard ratio=0.88 [0.79-0.97] in women and absolute difference, 2%; hazard ratio=0.95 [0.91-0.998] in men; interaction P=0.17). In subgroups according to QRS duration, CRT-D was associated with better survival in both sexes with LBBB and QRS ≥130 ms, whereas there was no clear relation between QRS duration and survival in patients without LBBB regardless of patient sex. CONCLUSIONS In a large real-world population CRT-D was associated with a lower mortality risk in both sexes with LBBB, although more pronounced among women. Only among those with LBBB, both sexes had better survival with longer QRS duration. The mortality differences in patients without LBBB were attenuated in both sexes.
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Affiliation(s)
- Robbert Zusterzeel
- From the Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD (R.Z., W.E.S., K.A.S., I.L.P., D.A.C., D.G.S.); Yale School of Medicine, New Haven, CT (E.S.S., J.P.C., H.B.); American College of Cardiology Foundation, Washington, DC (A.P.); VA Eastern Colorado Health Care System, University of Colorado, Denver (P.D.V.); Colorado Cardiovascular Outcomes Research Group, Denver (P.D.V.); and University of Colorado Anschutz Medical Campus, Aurora (F.A.M.)
| | - Erica S Spatz
- From the Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD (R.Z., W.E.S., K.A.S., I.L.P., D.A.C., D.G.S.); Yale School of Medicine, New Haven, CT (E.S.S., J.P.C., H.B.); American College of Cardiology Foundation, Washington, DC (A.P.); VA Eastern Colorado Health Care System, University of Colorado, Denver (P.D.V.); Colorado Cardiovascular Outcomes Research Group, Denver (P.D.V.); and University of Colorado Anschutz Medical Campus, Aurora (F.A.M.)
| | - Jeptha P Curtis
- From the Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD (R.Z., W.E.S., K.A.S., I.L.P., D.A.C., D.G.S.); Yale School of Medicine, New Haven, CT (E.S.S., J.P.C., H.B.); American College of Cardiology Foundation, Washington, DC (A.P.); VA Eastern Colorado Health Care System, University of Colorado, Denver (P.D.V.); Colorado Cardiovascular Outcomes Research Group, Denver (P.D.V.); and University of Colorado Anschutz Medical Campus, Aurora (F.A.M.)
| | - William E Sanders
- From the Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD (R.Z., W.E.S., K.A.S., I.L.P., D.A.C., D.G.S.); Yale School of Medicine, New Haven, CT (E.S.S., J.P.C., H.B.); American College of Cardiology Foundation, Washington, DC (A.P.); VA Eastern Colorado Health Care System, University of Colorado, Denver (P.D.V.); Colorado Cardiovascular Outcomes Research Group, Denver (P.D.V.); and University of Colorado Anschutz Medical Campus, Aurora (F.A.M.)
| | - Kimberly A Selzman
- From the Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD (R.Z., W.E.S., K.A.S., I.L.P., D.A.C., D.G.S.); Yale School of Medicine, New Haven, CT (E.S.S., J.P.C., H.B.); American College of Cardiology Foundation, Washington, DC (A.P.); VA Eastern Colorado Health Care System, University of Colorado, Denver (P.D.V.); Colorado Cardiovascular Outcomes Research Group, Denver (P.D.V.); and University of Colorado Anschutz Medical Campus, Aurora (F.A.M.)
| | - Ileana L Piña
- From the Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD (R.Z., W.E.S., K.A.S., I.L.P., D.A.C., D.G.S.); Yale School of Medicine, New Haven, CT (E.S.S., J.P.C., H.B.); American College of Cardiology Foundation, Washington, DC (A.P.); VA Eastern Colorado Health Care System, University of Colorado, Denver (P.D.V.); Colorado Cardiovascular Outcomes Research Group, Denver (P.D.V.); and University of Colorado Anschutz Medical Campus, Aurora (F.A.M.)
| | - Haikun Bao
- From the Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD (R.Z., W.E.S., K.A.S., I.L.P., D.A.C., D.G.S.); Yale School of Medicine, New Haven, CT (E.S.S., J.P.C., H.B.); American College of Cardiology Foundation, Washington, DC (A.P.); VA Eastern Colorado Health Care System, University of Colorado, Denver (P.D.V.); Colorado Cardiovascular Outcomes Research Group, Denver (P.D.V.); and University of Colorado Anschutz Medical Campus, Aurora (F.A.M.)
| | - Angelo Ponirakis
- From the Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD (R.Z., W.E.S., K.A.S., I.L.P., D.A.C., D.G.S.); Yale School of Medicine, New Haven, CT (E.S.S., J.P.C., H.B.); American College of Cardiology Foundation, Washington, DC (A.P.); VA Eastern Colorado Health Care System, University of Colorado, Denver (P.D.V.); Colorado Cardiovascular Outcomes Research Group, Denver (P.D.V.); and University of Colorado Anschutz Medical Campus, Aurora (F.A.M.)
| | - Paul D Varosy
- From the Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD (R.Z., W.E.S., K.A.S., I.L.P., D.A.C., D.G.S.); Yale School of Medicine, New Haven, CT (E.S.S., J.P.C., H.B.); American College of Cardiology Foundation, Washington, DC (A.P.); VA Eastern Colorado Health Care System, University of Colorado, Denver (P.D.V.); Colorado Cardiovascular Outcomes Research Group, Denver (P.D.V.); and University of Colorado Anschutz Medical Campus, Aurora (F.A.M.)
| | - Frederick A Masoudi
- From the Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD (R.Z., W.E.S., K.A.S., I.L.P., D.A.C., D.G.S.); Yale School of Medicine, New Haven, CT (E.S.S., J.P.C., H.B.); American College of Cardiology Foundation, Washington, DC (A.P.); VA Eastern Colorado Health Care System, University of Colorado, Denver (P.D.V.); Colorado Cardiovascular Outcomes Research Group, Denver (P.D.V.); and University of Colorado Anschutz Medical Campus, Aurora (F.A.M.)
| | - Daniel A Caños
- From the Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD (R.Z., W.E.S., K.A.S., I.L.P., D.A.C., D.G.S.); Yale School of Medicine, New Haven, CT (E.S.S., J.P.C., H.B.); American College of Cardiology Foundation, Washington, DC (A.P.); VA Eastern Colorado Health Care System, University of Colorado, Denver (P.D.V.); Colorado Cardiovascular Outcomes Research Group, Denver (P.D.V.); and University of Colorado Anschutz Medical Campus, Aurora (F.A.M.)
| | - David G Strauss
- From the Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD (R.Z., W.E.S., K.A.S., I.L.P., D.A.C., D.G.S.); Yale School of Medicine, New Haven, CT (E.S.S., J.P.C., H.B.); American College of Cardiology Foundation, Washington, DC (A.P.); VA Eastern Colorado Health Care System, University of Colorado, Denver (P.D.V.); Colorado Cardiovascular Outcomes Research Group, Denver (P.D.V.); and University of Colorado Anschutz Medical Campus, Aurora (F.A.M.).
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24
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Cheng YJ, Zhang J, Li WJ, Lin XX, Zeng WT, Tang K, Tang AL, He JG, Xu Q, Mei MY, Zheng DD, Dong YG, Ma H, Wu SH. More Favorable Response to Cardiac Resynchronization Therapy in Women Than in Men. Circ Arrhythm Electrophysiol 2014; 7:807-15. [PMID: 25146838 DOI: 10.1161/circep.113.001786] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background—
Data on sex difference in response to cardiac resynchronization therapy (CRT) remain controversial. We conducted a meta-analysis to summarize all published studies to determine whether sex-based differences in response to CRT exist.
Methods and Results—
We performed a literature search using MEDLINE (source PubMed; January 1966 to March 2014) and EMBASE (January 1980 to March 2014) with no restrictions. Pooled effect estimates were obtained by using random-effects meta-analysis. Seventy-two studies involving 33 434 patients were identified. Overall, female patients had better outcomes from CRT compared with male patients, with a significant 33% reduction in the risk of death from any cause (hazard ratio, 0.67; 95% confidence interval, 0.61–0.74;
P
<0.001), 20% reduction in death or hospitalization for heart failure (hazard ratio, 0.80; 95% confidence interval, 0.71–0.90;
P
<0.001), 41% reduction in cardiac death (hazard ratio, 0.59; 95% confidence interval, 0.42–0.84;
P
<0.001), and 41% reduction in ventricular arrhythmias or sudden cardiac death (hazard ratio, 0.59; 95% confidence interval, 0.49–0.70;
P
<0.001). These more favorable responses to CRT in women were consistently associated with greater echocardiographic evidence of reverse cardiac remodeling in women than in men.
Conclusions—
Women obtained greater reductions in the risk of death from any cause, cardiac cause, death or hospitalization for heart failure, and ventricular arrhythmias or sudden cardiac death with CRT therapy compared with men, with consistently greater echocardiographic evidence of reverse cardiac remodeling in women than in men. Further studies are needed to investigate the exact reasons for these results and determine whether indications for CRT in women should be different from men.
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Affiliation(s)
- Yun-Jiu Cheng
- From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.)
| | - Jing Zhang
- From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.)
| | - Wei-Jie Li
- From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.)
| | - Xiao-Xiong Lin
- From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.)
| | - Wu-Tao Zeng
- From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.)
| | - Kai Tang
- From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.)
| | - An-li Tang
- From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.)
| | - Jian-Gui He
- From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.)
| | - Qing Xu
- From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.)
| | - Mei-Yi Mei
- From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.)
| | - Dong-Dan Zheng
- From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.)
| | - Yu-Gang Dong
- From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.)
| | - Hong Ma
- From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.)
| | - Su-Hua Wu
- From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.)
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Cipriani M, Landolina M, Oliva F, Ghio S, Vargiu S, Rordorf R, Raineri C, Ammirati E, Petracci B, Campo C, Bisetti S, Lunati M. Women with nonischemic cardiomyopathy have a favorable prognosis and a better left ventricular remodeling than men after cardiac resynchronization therapy. J Cardiovasc Med (Hagerstown) 2014; 17:291-8. [PMID: 25222077 DOI: 10.2459/jcm.0000000000000187] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Cardiac resynchronization therapy (CRT) is a well established therapy in heart failure patients who are on optimal medical therapy and have reduced left ventricular ejection fraction (LVEF) and wide QRS complexes. Although women and patients with nonischemic cardiomyopathy are under-represented in CRT trials and registries, there is evidence that these two groups of patients can benefit more from CRT. The aim of our analysis was to investigate the impact of female sex on mortality in a population that included a high percentage of patients (61%) with nonischemic cardiomyopathy. METHODS We analyzed data on 507 consecutive patients (20% women) who received CRT at two Italian Heart Transplant centers and were followed up for a maximum of 48 months. RESULTS After multivariate adjustment, women showed a trend toward better survival with regard to all-cause mortality [hazard ratio (HR) 0.32, confidence interval (CI) 0.10-1.04; P = 0.059]. However, this benefit was limited to nonischemic patients with regard to all-cause mortality (HR 0.20, CI 0.05-0.87, P = 0.032) and cardiovascular mortality (HR 0.14, CI 0.02-1.05, P = 0.056). CONCLUSION Female CRT recipients, at mid-term, have a favorable prognosis than male patients and this benefit appears to be more evident in nonischemic patients. Thus, we strongly believe that the apparent under-utilization of CRT in females is an anomaly that should be corrected.
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Affiliation(s)
- Manlio Cipriani
- a'A De Gasperis' Cardiac Department, Niguarda Ca' Granda, Granda Hospital, Milan bCardiac Department, Policlinico San Matteo, Pavia cMedtronic Clinical Research Institute dMedtronic Italia S.p.A., Milano, Italy
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Zusterzeel R, Curtis JP, Caños DA, Sanders WE, Selzman KA, Piña IL, Spatz ES, Bao H, Ponirakis A, Varosy PD, Masoudi FA, Strauss DG. Sex-Specific Mortality Risk by QRS Morphology and Duration in Patients Receiving CRT. J Am Coll Cardiol 2014; 64:887-94. [DOI: 10.1016/j.jacc.2014.06.1162] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 05/20/2014] [Accepted: 06/03/2014] [Indexed: 10/24/2022]
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Gage RM, Burns KV, Bank AJ. Echocardiographic and clinical response to cardiac resynchronization therapy in heart failure patients with and without previous right ventricular pacing. Eur J Heart Fail 2014; 16:1199-205. [DOI: 10.1002/ejhf.143] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 06/19/2014] [Accepted: 06/25/2014] [Indexed: 11/11/2022] Open
Affiliation(s)
- Ryan M. Gage
- Research Division; United Heart & Vascular Clinic; 225 N. Smith Avenue, #400 St Paul MN USA
| | - Kevin V. Burns
- Research Division; United Heart & Vascular Clinic; 225 N. Smith Avenue, #400 St Paul MN USA
| | - Alan J. Bank
- Research Division; United Heart & Vascular Clinic; 225 N. Smith Avenue, #400 St Paul MN USA
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DI FUSCO STEFANIAANGELA, PALAZZO STEFANO, COLIVICCHI FURIO, SANTINI MASSIMO. The Influence of Gender on Heart Rhythm Disease. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 37:650-7. [DOI: 10.1111/pace.12369] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 01/11/2014] [Accepted: 01/17/2014] [Indexed: 01/08/2023]
Affiliation(s)
| | - STEFANO PALAZZO
- Cardiovascular Department; San Filippo Neri Hospital; Rome Italy
| | - FURIO COLIVICCHI
- Cardiovascular Department; San Filippo Neri Hospital; Rome Italy
| | - MASSIMO SANTINI
- Cardiovascular Department; San Filippo Neri Hospital; Rome Italy
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Schuchert A, Muto C, Maounis T, Frank R, Ella RO, Polauck A, Padeletti L. Gender-related safety and efficacy of cardiac resynchronization therapy. Clin Cardiol 2013; 36:683-90. [PMID: 24105909 DOI: 10.1002/clc.22203] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 08/01/2013] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) is an established therapy for patients with chronic heart failure (CHF) and a broad QRS complex. Gender-related safety and efficacy data are necessary for informed patient decision-making for female patients with CHF. The aim of the study was to assess the effects of gender on the outcome of CRT in highly symptomatic heart failure patients. HYPOTHESIS Gender may have an effect on the outcome of heart failure patients undergoing cardiac resynchronisation therapy. METHODS The study analyzed the 2-year follow-up of 393 New York Heart Association (NYHA) class III/IV patients with a class I CRT indication enrolled in the Management of Atrial Fibrillation Suppression in AF-HF Comorbidity Therapy (MASCOT) study. RESULTS In female patients (n = 82), compared with male patients (n = 311), CHF was more often due to dilated cardiomyopathy (74% vs 44%, respectively; P < 0.0001). Females also had a more impaired quality-of-life score and a smaller left ventricular end-diastolic diameter (LVEDD). Women were less likely than men to have received a CRT defibrillator (35% vs 61%, respectively; P < 0.0001). After 2 years, the devices had delivered more biventricular pacing in women than in men (96% ± 13% vs 94% ± 13%, respectively; P < 0.0004). Women had a greater reduction in LVEDD than did men (-8.2 mm ± 11.1 mm vs -1.1 mm ± 22.1 mm, respectively; P < 0.02). Both genders improved similarly in NYHA functional class. Women reported greater improvement than men in quality-of-life score (-21.1 ± 26.5 vs -16.2 ± 22.1, respectively; P < 0.0001). After adjustment for cardiovascular history, women had lower all-cause mortality (P = 0.0007), less cardiac death (P = 0.04), and fewer hospitalizations for worsening heart failure (P = 0.01). CONCLUSIONS Females exhibited a better response to CRT than did males. Because females have such impressive benefits from CRT, improved screening and advocacy for CRT implantation in women should be considered.
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Loring Z, Strauss DG, Gerstenblith G, Tomaselli GF, Weiss RG, Wu KC. Cardiac MRI scar patterns differ by sex in an implantable cardioverter-defibrillator and cardiac resynchronization therapy cohort. Heart Rhythm 2013; 10:659-65. [PMID: 23313802 PMCID: PMC3636172 DOI: 10.1016/j.hrthm.2013.01.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND Recent meta-analyses suggest that the effectiveness of cardiac devices may differ between genders. Compared to men, women may not benefit as much from implantable cardioverter-defibrillators (ICDs), yet benefit more from cardiac resynchronization therapy (CRT). Myocardial scar burden is associated with increased incidence of appropriate ICD shocks but decreased response to CRT and may explain gender differences in device benefit. OBJECTIVE To test the hypothesis that the extent of myocardial scar is less in women than men. METHODS In 235 patients referred for primary prevention ICDs who underwent cardiac magnetic resonance imaging, we compared scar size by gender. Analyses were performed for all patients (ICD cohort) and those receiving biventricular pacemakers (CRT subgroup). RESULTS In the ICD cohort, women (vs men) had a higher prevalence of nonischemic cardiomyopathy (NICM; 64% vs 39%; P<.001), which accounted for a smaller overall scar burden (0.5% vs 13%, P<.01). Likewise, in the CRT subgroup, the higher prevalence of NICM in women (83% vs 46%; P = .01) also contributed to a smaller scar size (0% vs 13%; P<.01). Women also had significantly less scarring of the inferolateral left ventricular wall. CONCLUSIONS In a cohort of patients undergoing clinically indicated ICD and CRT, women had less myocardial scar than did men. This difference was primarily driven by a higher prevalence of NICM in women. These findings may have important implications for the future study of gender disparities in ICD and CRT outcomes.
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Affiliation(s)
- Zak Loring
- Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring MD, USA
- Duke University School of Medicine, Durham, NC, USA
| | - David G. Strauss
- Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring MD, USA
| | - Gary Gerstenblith
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Gordon F. Tomaselli
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Robert G. Weiss
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Katherine C. Wu
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
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Fairweather D, Cooper LT, Blauwet LA. Sex and gender differences in myocarditis and dilated cardiomyopathy. Curr Probl Cardiol 2013; 38:7-46. [PMID: 23158412 DOI: 10.1016/j.cpcardiol.2012.07.003] [Citation(s) in RCA: 211] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Heart failure due to nonischemic dilated cardiomyopathy (DCM) contributes significantly to the global burden of cardiovascular disease. Myocarditis is, in turn, a major cause of acute DCM in both men and women. However, recent clinical and experimental evidence suggests that the pathogenesis and prognosis of DCM differ between the sexes. This seminar provides a contemporary perspective on the immune mediators of myocarditis, including interdependent elements of the innate and adaptive immune response. The heart's acute response to injury is influenced by sex hormones that appear to determine the subsequent risk of chronic DCM. Preliminary data suggest additional genetic variations may account for some of the differences in epidemiology, left ventricular recovery, and survival between men and women. We highlight the gaps in our knowledge regarding the management of women with acute DCM and discuss emerging therapies, including bromocriptine for the treatment of peripartum cardiomyopathy.
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Cheng A, Gold MR, Waggoner AD, Meyer TE, Seth M, Rapkin J, Stein KM, Ellenbogen KA. Potential mechanisms underlying the effect of gender on response to cardiac resynchronization therapy: Insights from the SMART-AV multicenter trial. Heart Rhythm 2012; 9:736-41. [DOI: 10.1016/j.hrthm.2011.12.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Indexed: 11/26/2022]
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van der Wall EE. Gender-specific findings in interventional cardiology: negative for PCI, positive for CRT? Neth Heart J 2011. [DOI: 10.1007/s12471-011-0196-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Gender-specific findings in interventional cardiology: negative for PCI, positive for CRT? Neth Heart J 2011. [DOI: 10.1007/s12471-011-0193-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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