Key result
Women undergoing CRT present with ~46% less ischemic cardiomyopathy and shorter QRS durations than men.
Why the study?
Response to CRT is associated with clinical characteristics including gender, but the relation of gender and baseline characteristics with QRS duration and KCCQ needed assessment.
Do baseline clinical characteristics and quality of life differ between men and women undergoing cardiac resynchronization therapy?
RCT (n=3,620)
randomized
Yes
Do baseline clinical characteristics and quality of life differ between men and women undergoing cardiac resynchronization therapy?
Women undergoing cardiac resynchronization therapy present with significantly different baseline profiles than men, including more severe symptoms, lower quality of life, and less ischemic etiology.
Sex differences in CRT candidates should not yet alter selection; leaves open whether they modify response in prospective trials.
AIMS: Response to cardiac resynchronization therapy (CRT) is known to be associated with a number of clinical characteristics, including QRS duration and morphology, gender, height, and the aetiology of heart failure (HF). We assessed the relation of gender and baseline characteristics with QRS duration and Kansas City Cardiomyopathy Questionnaire. METHODS AND RESULTS: AdaptResponse is a global randomized trial. The trial enrolled CRT-indicated patients with New York Heart Association classes II-IV HF, left bundle branch block (QRS ≥ 140 ms in men, ≥130 ms in women), and baseline PR interval ≤200 ms. In total, 3620 patients were randomized, including 1569 women (43.3%) approaching the actual proportion of women in the HF population. Women were older and more often New York Heart Association class III or IV than men (55.6% vs. 48.7%), had less frequent ischaemic cardiomyopathy (21.2% vs. 39.5%), and had a 5.1 ms shorter QRS duration than men. Women were more often depressed (18.5% vs. 9.7%), had a significantly lower Kansas City Cardiomyopathy Questionnaire score, and had differences in medication prescriptions. CONCLUSIONS: AdaptResponse is the largest randomized CRT trial and enrolled more women than any other landmark CRT trial. Women differed from men with regard to baseline characteristics and quality of life. Whether these differences translate into clinical outcome differences will be examined further in the AdaptResponse trial.
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Wilkoff et al. (2020) conducted an RCT in Heart failure (n=3,620). Cardiac resynchronization therapy vs. Men was evaluated on Relation of gender and baseline characteristics with QRS duration and Kansas City Cardiomyopathy Questionnaire. Among 3620 patients undergoing cardiac resynchronization therapy, women had less frequent ischemic cardiomyopathy (21.2% vs. 39.5%) and a 5.1 ms shorter QRS duration compared to men.
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