Key result
In patients with CAD and severely reduced LVEF, female gender was associated with significantly worse survival compared to men (HR 2.02; 95% CI 1.31-3.12; P=0.001), irrespective of scar burden.
Why the study?
Does female gender predict worse survival compared to male gender in patients with severe LV dysfunction and CAD?
Cohort (n=339)
Does female gender predict worse survival compared to male gender in patients with severe LV dysfunction and CAD?
In patients with CAD and severely reduced LVEF, women have significantly worse survival outcomes than men, independent of myocardial scar burden measured by CMR.
May indicate need for gender-specific risk stratification in CAD with low LVEF; leaves open mechanisms and therapeutic implications.
AIMS: We sought to determine the association between myocardial scarring, gender, and survival in patients with significant coronary artery disease (CAD) and severe systolic left ventricular (LV) dysfunction using delayed hyper-enhancement cardiac magnetic resonance imaging (DHE-CMR). METHODS AND RESULTS: We studied 339 patients (24% women, mean age 65 +/- 11 years) referred for assessment of myocardial viability by DHE-CMR. Scar was defined as myocardium with an intensity >2 SD above viable myocardium. Left ventricular scar (defined as a percentage of total LV myocardium), LV volumes, risk factors, cardiac transplantation (CTx), and all-cause mortality were recorded. There were 84 deaths and five CTx over 3.7 +/- 1.6 years (median 4 years, interquartile range 2.6-4.9 years). Left ventricular ejection fraction (LVEF) in men was only slightly different from women (23% +/- 9 vs. 25% +/- 10, P = 0.05), whereas mean scar % was similar in both groups (32 +/- 21 vs. 29 +/- 20, P = 0.3). On univariable survival analysis, age [hazard ratio, HR, 1.03 (1.01-1.05), P = 0.002], female gender [HR 2.02 (1.31-3.12), P = 0.001], and scar % [HR 1.01 (1.003-1.02), P = 0.009] predicted outcomes; and also on multivariable analysis (chi(2) 32, P < 0.0001). Women with scar % greater than the median had more events, compared with men with or without a high scar burden (log-rank P < 0.001). CONCLUSION: In patients with CAD and severely reduced LVEF, women have worse outcomes than men, irrespective of myocardial scar burden.
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Kwon et al. (2009) conducted a cohort in Significant coronary artery disease and severe systolic left ventricular dysfunction (n=339). Female gender vs. Male gender was evaluated on All-cause mortality and cardiac transplantation (HR 2.02, 95% CI 1.31-3.12, p=0.001). In patients with CAD and severely reduced LVEF, female gender was associated with significantly worse survival compared to men (HR 2.02; 95% CI 1.31-3.12; P=0.001), irrespective of scar burden.
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