Heart failure therapy more effective in certain populations

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Women who received cardiac resynchronization therapy with defibrillator (CRT-D) to prevent heart failure (HF) progression had significantly better outcomes than men, study results suggest.

Aysha Arshad, MD, director of the ECG lab at St. Luke's Roosevelt Hospital and assistant professor at Columbia University, both in New York City, analyzed data from the MADIT-CRT trial along with colleagues from several other U.S. sites, to determine whether patient outcomes varied according to gender.

They compared the effects of therapy with CRT-D or implanted cardioverter defibrillator (ICD) in 453 women and 1,367 men who participated in the MADIT-CRT trail. Results were published online in the Journal of the American College of Cardiology.

The researchers found that women who received CRT-D experienced a 69% reduction in death or HF (HR=0.31; P<.001) and a 70% reduction in HF alone compared with men (HR=0.30; P<.001). Furthermore, women who had QRS duration ≥150 ms experienced an 82% reduction, and those who had left bundle branch block conduction disturbance experienced a 78% reduction in mortality compared with men.

“These more favorable results for women were associated with consistently greater ECG evidence of reverse cardiac remodeling in women than in men,” the researchers wrote.

However, James T. Willerson, MD, of the University of Texas Health Science Center in Houston, questioned whether women truly benefitted more than men in an accompanying editorial.

“The clinical imbalance between the frequency of nonischemic versus ischemic cardiomyopathies between the two groups diminish our confidence in the concept that women benefit more than men,” he wrote.

Twice as many of the study's women participants had nonischemic cardiomyopathy compared with men (72 vs. 36), and more than double the men had ischemic heart disease than women (64 vs. 38), data indicate. Furthermore, CRT-D did not significantly reduce the incidence of death or HF in women with ischemic heart disease compared with men.

Willerson added that the absolute differences in hemodynamic reverse remodeling variables including left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV) and left ventricular ejection fraction (LVEF) between the two groups were small.

“I believe one can conclude from the study that women and men with LVEF <30%, QRS duration ≥130 ms and class I or class II symptoms benefit from CRT-D, and that is especially so for women with nonischemic cardiomyopathies and left bundle branch block or QRS durations ≥150 ms,” he wrote.

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