Iranian Heart Journal

Iranian Heart Journal

Evaluation of Gender Differences in Response to Cardiac Resynchronization Therapy in a Single Heart Center

Authors
Shabnam Madadi 1
Leili Mohimi 2
Majid Haghjoo 1
Amir Farjam Fazelifar 1
Abolfath Alizadeh 1
Zahra Emkanjoo 1
1 Cardiac Electrophysiology Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
2 Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
Abstract
Background: Cardiac resynchronization therapy (CRT) has a beneficial effect on clinical symptoms, exercise capacity, and systolic left ventricular (LV) performance in patients with heart failure. The objective of the current study was to evaluate whether a gender difference exists in response to CRT according to clinical indices. Methods: Totally, 229 consecutive patients with end-stage heart failure (LV ejection fraction ≤35%), QRS duration >120 ms, and left bundle branch block configuration underwent CRT. At baseline and 6 months post-CRT, clinical and echocardiographic parameters were evaluated and followed-up was obtained for up to 6 months. The clinical alterations after CRT implantation were compared between the men and the women. Results: The study population consisted of 229 patients [129 (56.3%) male and 100 (43.7%) female; mean age=62.90±12.97 y, and age range=9–24]. No significant difference between the men and the women regarding age was found [men=62.13±14.26 y and women=63.89±11.12 y (P=0.3)]. The mean of the QRS width after CRT implantation in the men and the women was 147.50±23.09 and 145±18.45 ms, respectively, and the difference between the 2 groups was significant (P=0.001). There was no significant relationship between sex and hospitalization (P=0.09). At 6 months’ follow-up, LV ejection fraction in the men and the women was 18.56±6.18 and 20.78±8.96, respectively (P=0.1). Conclusions: At 6 months’ follow-up, most of the patients had a normal sinus rhythm. Most of the deaths were seen in the males. The men had a slightly greater QRS width after CRT implantation in than the women. The chief reasons for hospitalization and mortality were shock and heart failure decompensation. LV ejection fraction before and after CRT was significantly greater in the female patients than in their male counterparts; however, the difference was significant before the implantation
Keywords
Cardiac resynchronization therapy
CRT, QRS duration, Gender, Heart failure, Ejection fraction, Left ventricle, Cardiomyopathy
  1. Epstein AE, DiMarco JP, Ellenbogen KA, et al. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices). J Am Coll Cardiol 2008;51:e1–62.
  2. M. Dupont, J. Rickard, B. Baranowski, N. Varma, T. Dresing, A. Gabi, M. Finucan, W. Mullens, B.L. Wilkoff, W.H. Tang Differential response to CRT and clinical outcomes according to QRS morphology and QRS duration J Am Coll Cardiol, 60 (2012), pp. 592–598
  3. C.M. Tracy, A.E. Epstein, D. Darbar, et al. 2012 ACCF/AHA/HRS focused update of the 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the ACC/AHA task force on practice guidelines and the Heart rhythm Society [corrected] Circulation, 126 (2012), pp. 1784–1800
  4. S. Ghio, N. Freemantle, L. Scelsi, A. Serio, G. Magrini, M. Pasotti, A. Shankar, J.G. Cleland, L. Tavazzi  Long-term left ventricular reverse remodelling with cardiac resynchronization therapy: results the CARE-HF trial Eur J Heart Fail, 11 (2009), pp. 480–488
  5. A. Auricchio, F.W. Prinzen Non-responders to CRT: the magnitude of the problem and the issues Circ J, 75 (2011), pp. 521–527
  6. Auricchio, F.W. Prinzen Non-responders to CRT: the magnitude of the problem and the issues  Circ J, 75 (2011), pp. 521–527
  7. Arshad, A.J. Moss, E. Foster, L. Padeletti, A. Barsheshet, I. Goldenberg, H. Greenberg, W.J. Hall, S. McNitt, W. Zareba, S. Solomon, J.S. Steinberg CRT is more effective in women than in men: the MADIT-CRT trial J Am Coll Cardiol, 57 (2011), pp. 813–820
  8. Auricchio, F.W. Prinzen Non-responders to CRT: the magnitude of the problem and the issues Circ J, 75 (2011), pp. 521–527
  9. Auricchio, F.W. Prinzen Non-responders to CRT: the magnitude of the problem and the issues Circ J, 75 (2011), pp. 521–527
  10. Cazeau S, Leclercq C, Lavergne T, et al. Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N Engl J Med 2001; 344:873–880.
  11. Cardiac Resynchronization Therapy, Is More Effective in Women Than in Men The MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy) Trial. Aysha Arshad, Arthur J. Moss, Elyse Foster, Luigi Padeletti, Alon Barsheshet, Ilan Goldenberg, Henry Greenberg, W. Jackson Hall, Scott McNitt, Wojciech Zareba, Scott Solomon, Jonathan S. Steinberg; Journal of the American College of Cardiology 2011: 57; 7: 201
  12. Moss AJ, Hall WJ, Cannom DS, et al. Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med 2009;361: 1329 –38.
  13. Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification: a report the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group. J Am Soc Echocardiogr 2005;18:1440–63.
  14.  Kaplan EL, Meier P. Nonparametric estimation incomplete observations. J Am Stat Assoc 1958;53: 457–81.
  15. Daubert C, Gold MR, Abraham WT, et al. Prevention of disease progression by cardiac resynchronization therapy in patients with asymptomatic or mildly symptomatic left ventricular dysfunction: insights the European cohort of the REVERSE (Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction) trial. J Am Coll Cardiol 2009;54: 1837–46.
  16. Ghali JK, Krause-Steinrauf HJ, Adams KF, et al. Gender differences in advanced heart failure: insights the BEST study. J Am Coll Cardiol 2003;42:2128–34.
  17. Crow RS, Hannan PJ, Folsom AR. Prognostic significance of corrected QT and corrected JT interval for incident coronary heart disease in a general population sample stratified by presence or absence of wide QRS complex: the ARIC study with 13 years of follow-up. Circulation 2003;108:1985–9
  18. Kashani A, Barold SS. Significance of QRS complex in patients with heart failure. J Am Coll Cardiol 2005;46: 2183–92
  19. Bristow MR, Saxon LA, Boehmer J, et al. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 2004; 350:2140.

 

Iranian Heart Journal
Volume 20, Issue 2
Spring 2019
Pages 13-20