Women with nonischemic cardiomyopathy have a favorable prognosis and a better left ventricular remodeling than men after cardiac resynchronization therapy
Women with nonischemic cardiomyopathy have a favorable prognosis and a better left ventricular remodeling than men after cardiac resynchronization therapy
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DOI：
10.2459/jcm.0000000000000187
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发表时间：
2016-04-01
影响因子：
3
通讯作者：
Lunati, Maurizio
中科院分区：
文献类型：
--
作者：
Cipriani, Manlio;Landolina, Maurizio;Lunati, Maurizio
心脏再同步化治疗（CRT）是一种成熟的治疗心力衰竭患者的最佳药物治疗，降低左心室射血分数（LVEF）和宽QRS复合物。尽管女性和非缺血性心肌病患者在CRT试验和登记中代表性不足，但有证据表明这两组患者可以从CRT中获益更多。我们分析的目的是调查女性对包括高比例（61%）非缺血性心肌病患者的人群死亡率的影响。方法分析507例在意大利两家心脏移植中心连续接受CRT治疗的患者（20%为女性）的资料，并对其进行最长48个月的随访。结果经多因素调整后，女性在全因死亡率方面表现出更好的生存趋势[危险比（HR） 0.32，置信区间（CI） 0.10-1.04；P = 0.059)。然而，这种益处仅限于非缺血性患者的全因死亡率（HR 0.20, CI 0.05-0.87， P=0.032）和心血管死亡率（HR 0.14, CI 0.02-1.05， P=0.056）。结论女性CRT患者中期预后较男性患者好，且在非缺血性患者中更为明显。因此，我们强烈认为，CRT在女性中的明显利用不足是一种应该纠正的异常现象。
AimsCardiac resynchronization therapy (CRT) is a well established therapy in heart failure patients who are on optimal medical therapy and have reduced left ventricular ejection fraction (LVEF) and wide QRS complexes. Although women and patients with nonischemic cardiomyopathy are under-represented in CRT trials and registries, there is evidence that these two groups of patients can benefit more from CRT. The aim of our analysis was to investigate the impact of female sex on mortality in a population that included a high percentage of patients (61%) with nonischemic cardiomyopathy.MethodsWe analyzed data on 507 consecutive patients (20% women) who received CRT at two Italian Heart Transplant centers and were followed up for a maximum of 48 months.ResultsAfter multivariate adjustment, women showed a trend toward better survival with regard to all-cause mortality [hazard ratio (HR) 0.32, confidence interval (CI) 0.10-1.04; P=0.059]. However, this benefit was limited to nonischemic patients with regard to all-cause mortality (HR 0.20, CI 0.05-0.87, P=0.032) and cardiovascular mortality (HR 0.14, CI 0.02-1.05, P=0.056).ConclusionFemale CRT recipients, at mid-term, have a favorable prognosis than male patients and this benefit appears to be more evident in nonischemic patients. Thus, we strongly believe that the apparent under-utilization of CRT in females is an anomaly that should be corrected.