Abstract 16980: Females with Ischemic Cardiomyopathy Have Worse Outcomes with Cardiac Resynchronization Therapy (CRT) Compared to Males
Background: Although prior work has suggested that women demonstrate better outcomes with CRT than men, the impact of ischemic cardiomyopathy in this group remains uncertain.
Methods: A prospective cohort of patients undergoing CRT in a single center was evaluated. Echocardiographic response was assessed at baseline and 6 months. Primary clinical outcome was a composite of time to all-cause death, cardiac transplant, and left ventricular assist device (LVAD) placement at 5 years.
Results: The study set consisted of 428 patients (age 72.8 ± 9.4 years, LVEF 23.8± 7.0%): 19% were women (n=81); 30% of women and 65% of males had history of ischemic cardiomyopathy (n=250 total). Baseline characteristics were comparable between ischemic men and women. Among ischemic patients, females fared significantly worse than males with respect to the primary outcome (p=0.0437) (Figure). Multivariate analysis demonstrated that higher creatinine (p=0.0039) and baseline NYHA class (p=0.0185) were independent predictors of worse outcome. Women with ischemic cardiomyopathy demonstrated similar change in LVEF (+5.9 ±11.3%) vs men, (+5.4 ± 10% for men, p=NS), but more improvement in LV internal dimension in diastole (-10 ±9.7% vs -3.3 ± 8.8%, p=0.023).
Conclusions: Despite favorable echocardiographic remodeling after CRT, women with ischemic cardiomyopathy demonstrate significantly worse clinical outcomes than men. Further investigation of the gender-specific impact of CRT in ischemic cardiomyopathy appears warranted.
- © 2012 by American Heart Association, Inc.