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The gender gap in cardiac resynchronisation therapy
Session:
Sessão de Comunicações Orais - Dispositivos Médicos
Speaker:
James Milner
Congress:
CPC 2020
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.3 Cardiac Resynchronization Therapy
Session Type:
Comunicações Orais
FP Number:
---
Authors:
James Milner; Sofia S. Martinho; Cátia Santos Ferreira; André Azul Freitas; José Paulo Almeida; João André Ferreira; Natália António; Miguel Ventura; João Cristóvão; Luis Elvas; Lino Gonçalves
Abstract
<p>Background: Despite conflicting evidence that females may respond more favourably to cardiac resynchronization therapy (CRT), they have been underrepresented in major trials. We aim to evaluate response to CRT and long-term outcomes in female patients submitted to resynchronization.</p> <p>Methods and population: Single-center, retrospective study of 434 consecutive patients submitted to CRT between 2004 and 2014. Patients were sorted into 2 groups according to gender: Group A, with 302 males patients (70%) and group B, with 132 female patients (30%). Baseline demographic, clinical and echocardiographic characteristics were compared. Median follow-up was 31 months. The primary co-endpoints were response to CRT (defined as a reduction in left ventricular end-systolic volume of ≥15% at 6-months follow up), readmission due to decompensated heart failure (HF), progression to heart transplantation and all-cause mortality.</p> <p>Results: Age at CRT implantation was similar in both groups (65±11), with a higher prevalence of non-ischemic etiology in women (70 vs 55%, p=.01). Most patients received CRT with defibrillator in both groups. Similar prevalence of other co-morbidities (such as arterial hypertension, dyslipidemia, type 2 diabetes mellitus and chronic kidney disease) and pharmacological therapy were registered, except for more males taking statins (74 vs 59%, p=.006). Basal QRS duration was longer in females (154±25 vs 143±32, p=.03), but left ventricular ejection fraction was similar in both groups (26±7 vs 27±7, p=.224). During follow-up, 26% of males with no prior history of atrial fibrillation (AF) developed AF, which happened in only 12% of female patients (p=.007). Women exhibited better echocardiographic (66 vs 46%, p=.002) and functional (68 vs 54%, p=.039) response to CRT and, despite similar progression to heart transplantation and all-cause mortality, readmission due to decompensated HF was higher in males (34 vs 24%, p=.005). In multivariate analysis, after adjustment for HF etiology, AF development and QRS duration, female gender remained as an independent predictor of response to CRT (OR 2.723, 95% CI 1.083-6.845, p=.033).</p> <p>Conclusions: In this cohort, female gender was associated with better response to CRT and less readmissions for decompensated HF. Though factors such as less ischemic etiology and less AF development may contribute towards this difference, female gender was an independent predictor of response to CRT in our model. </p>
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