Key result
Female sex was associated with a lower risk of all-cause mortality, LV assist device implantation, or heart transplantation after cardiac resynchronization therapy.
Why the study?
Women respond better to cardiac resynchronization therapy at shorter QRS duration, and whether relatively larger LV electrical dyssynchrony in smaller hearts explains this response was unknown.
Does heart size-corrected electrical dyssynchrony explain the better response to cardiac resynchronization therapy in women compared to men?
Observational (n=725)
Yes
Does heart size-corrected electrical dyssynchrony explain the better response to cardiac resynchronization therapy in women compared to men?
Answers are grounded in this paper and cite their sources.
Greater electrical dyssynchrony relative to heart size in women partially explains their better reverse remodeling after CRT, but does not fully explain their superior long-term clinical outcomes compared to men.
Background: Women are less likely to receive cardiac resynchronization therapy, yet, they are more responsive to the therapy and respond at shorter QRS duration. The present study hypothesized that a relatively larger left ventricular (LV) electrical dyssynchrony in smaller hearts contributes to the better cardiac resynchronization therapy response in women. For this, the vectorcardiography-derived QRS area is used, since it allows for a more detailed quantification of electrical dyssynchrony compared with conventional electrocardiographic markers. Methods: Data from a multicenter registry of 725 cardiac resynchronization therapy patients (median follow-up, 4.2 years [interquartile range, 2.7–6.1]) were analyzed. Baseline electrical dyssynchrony was evaluated using the QRS area and the corrected QRS area for heart size using the LV end-diastolic volume (QRSarea/LVEDV). Impact of the QRSarea/LVEDV ratio on the association between sex and LV reverse remodeling (LV end-systolic volume change) and sex and the composite outcome of all-cause mortality, LV assist device implantation, or heart transplantation was assessed. Results: At baseline, women (n=228) displayed larger electrical dyssynchrony than men (QRS area, 132±55 versus 123±58 μVs; P =0.043), which was even more pronounced for the QRSarea/LVEDV ratio (0.76±0.46 versus 0.57±0.34 μVs/mL; P <0.001). After multivariable analyses, female sex was associated with LV end-systolic volume change (β=0.12; P =0.003) and a lower occurrence of the composite outcome (hazard ratio, 0.59 [0.42–0.85]; P =0.004). A part of the female advantage regarding reverse remodeling was attributed to the larger QRSarea/LVEDV ratio in women (25-fold change in β from 0.12 to 0.09). The larger QRSarea/LVEDV ratio did not contribute to the better survival observed in women. In both volumetric responders and nonresponders, female sex remained strongly associated with a lower risk of the composite outcome (adjusted hazard ratio, 0.59 [0.36–0.97]; P =0.036; and 0.55 [0.33–0.90]; P =0.018, respectively). Conclusions: Greater electrical dyssynchrony in smaller hearts contributes, in part, to more reverse remodeling observed in women after cardiac resynchronization therapy, but this does not explain their better long-term outcomes.
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Salden et al. (2020) conducted an observational in Patients receiving cardiac resynchronization therapy (n=725). Female sex vs. Male sex was evaluated on Composite outcome of all-cause mortality, LV assist device implantation, or heart transplantation (HR 0.59, 95% CI 0.42-0.85, p=0.004). Female sex was associated with a lower risk of all-cause mortality, LV assist device implantation, or heart transplantation after cardiac resynchronization therapy.
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