TY - JOUR
T1 - Aetiology of heart failure, rather than sex, determines reverse lv remodelling response to crt
AU - Said, Fatema
AU - ter Maaten, Jozine M.
AU - Martens, Pieter
AU - Vernooy, Kevin
AU - Meine, Mathias
AU - Allaart, Cornelis P.
AU - Geelhoed, Bastiaan
AU - Vos, Marc A.
AU - Cramer, Maarten J.
AU - van Gelder, Isabelle C.
AU - Mullens, Wilfried
AU - Rienstra, Michiel
AU - Maass, Alexander H.
N1 - Funding Information: Author Contributions: Disclosures, F.S., J.M.t.M., B.G., M.J.C. and M.R. have nothing to dis-close. P.M. has received a research grant from Vifor pharma and Fonds Wetenschappelijk Onderzoek (grant number: 1127917N) and consultancy fees from AstraZeneca, Abbott, Bayer, Boehringer-Ingelheim, Novartis, Novo Nordisk and Vifor pharma. K.V. has received consultan-cy fees from Medtronic, Abbott, Boston and Philips. A.H.M. received lecture fees from Med-tronic and LivaNova. Conceptualization, F.S., J.M.t.M., A.H.M.; methodology, F.S., J.M.t.M., B.G., A.H.M.; formal analysis, F.S., J.M.t.M., B.G.; data curation, P.M.; writing—original draft, F.S.; writing—review and editing, J.M.t.M., P.M., K.V., M.M., C.P.A., B.G., M.A.V., M.J.C., I.C.v.G., W.M., M.R., A.H.M.; supervision, J.M.t.M., A.H.M. All authors have read and agreed to the published version of the manuscript. Funding Information: Funding: The MARC study was performed within the framework of the CTMM, the Centre for Translational Molecular Medicine (www.ctmm.nl), project COHFAR (Congestive Heart Failure and Arrhythmias, grant 01C–203), and supported by the Dutch Heart Foundation. Publisher Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland.
PY - 2021/12/1
Y1 - 2021/12/1
N2 - Introduction: Cardiac resynchronization therapy (CRT) is an established therapy for patients with heart failure with reduced ejection fraction (HFrEF). Women appear to respond differently to CRT, yet it remains unclear whether this is inherent to the female sex itself, or due to other patient characteristics. In this study, we aimed to investigate sex differences in response to CRT. Methods: This is a post-hoc analysis of a prospective, multicenter study (MARC) in the Netherlands, studying HFrEF patients with an indication for CRT according to the guidelines (n = 240). Primary outcome measures are left ventricular ejection fraction (LVEF) and left ventricular end systolic volume (LVESV) at 6 months follow-up. Results were validated in an independent retrospective Belgian cohort (n = 818). Results: In the MARC cohort 39% were women, and in the Belgian cohort 32% were women. In the MARC cohort, 70% of the women were responders (defined as >15% decrease in LVESV) at 6 months, compared to 55% of men (p = 0.040) (79% vs. 67% in the Belgian cohort, p = 0.002). Women showed a greater decrease in LVESV %, LVESV indexed to body surface area (BSA) %, and increase in LVEF (all p < 0.05). In regression analysis, after adjustment for BSA and etiology, female sex was no longer associated with change in LVESV % and LVESV indexed to BSA % and LVEF % (p > 0.05 for all). Results were comparable in the Belgian cohort. Conclusions: Women showed a greater echocardiographic response to CRT at 6 months follow-up. However, after adjustment for BSA and ischemic etiology, no differences were found in LV-function measures or survival, suggesting that non-ischemic etiology is responsible for greater response rates in women treated with CRT.
AB - Introduction: Cardiac resynchronization therapy (CRT) is an established therapy for patients with heart failure with reduced ejection fraction (HFrEF). Women appear to respond differently to CRT, yet it remains unclear whether this is inherent to the female sex itself, or due to other patient characteristics. In this study, we aimed to investigate sex differences in response to CRT. Methods: This is a post-hoc analysis of a prospective, multicenter study (MARC) in the Netherlands, studying HFrEF patients with an indication for CRT according to the guidelines (n = 240). Primary outcome measures are left ventricular ejection fraction (LVEF) and left ventricular end systolic volume (LVESV) at 6 months follow-up. Results were validated in an independent retrospective Belgian cohort (n = 818). Results: In the MARC cohort 39% were women, and in the Belgian cohort 32% were women. In the MARC cohort, 70% of the women were responders (defined as >15% decrease in LVESV) at 6 months, compared to 55% of men (p = 0.040) (79% vs. 67% in the Belgian cohort, p = 0.002). Women showed a greater decrease in LVESV %, LVESV indexed to body surface area (BSA) %, and increase in LVEF (all p < 0.05). In regression analysis, after adjustment for BSA and etiology, female sex was no longer associated with change in LVESV % and LVESV indexed to BSA % and LVEF % (p > 0.05 for all). Results were comparable in the Belgian cohort. Conclusions: Women showed a greater echocardiographic response to CRT at 6 months follow-up. However, after adjustment for BSA and ischemic etiology, no differences were found in LV-function measures or survival, suggesting that non-ischemic etiology is responsible for greater response rates in women treated with CRT.
KW - Cardiac resynchronization therapy
KW - Heart failure
KW - Sex differences
UR - http://www.scopus.com/inward/record.url?scp=85119702626&partnerID=8YFLogxK
U2 - https://doi.org/10.3390/jcm10235513
DO - https://doi.org/10.3390/jcm10235513
M3 - Article
C2 - 34884215
SN - 0009-9147
VL - 10
JO - Clinical Chemistry
JF - Clinical Chemistry
IS - 23
M1 - 5513
ER -