Left Bundle Branch Block Predicts Better Survival in Women Than Men Receiving Cardiac Resynchronization Therapy Long-Term Follow-Up of ∼145,000 Patients
Left Bundle Branch Block Predicts Better Survival in Women Than Men Receiving Cardiac Resynchronization Therapy Long-Term Follow-Up of ∼145,000 Patients
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DOI：
10.1016/j.jchf.2013.03.005
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发表时间：
2013-06-01
影响因子：
13
通讯作者：
Strauss, David G.
中科院分区：
文献类型：
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作者：
Loring, Zak;Canos, Daniel A.;Strauss, David G.
目的 本研究的目的是检验以下假设：在心脏再同步治疗除颤器 (CRT-D) 接受者中，传统左束支传导阻滞 (LBBB) 诊断预测女性比男性有更好的生存率。 背景 纽约心脏协会 I 级和 II 级无 LBBB 患者不会从 CRT-D 中受益，并且 CRT-D 后女性比男性有更好的生存率。单独的分析表明，LBBB 诊断的 QRS 持续时间阈值因性别而异，并且传统 LBBB 心电图标准在男性中比女性更容易出现假阳性。 方法 我们分析了 2002 年至 2008 年间 144,642 名 CRT-D 接受者的医疗保险记录，并进行了长达 90 个月的随访。医疗保险账单数据用于确定年龄、性别、种族和合并症。计算风险比 (HR)，以评估传统 LBBB 诊断是否根据性别具有不同的预后意义。 结果 在单变量分析中，LBBB 与女性死亡率降低 31% 相关（HR：0.69 [95% 置信区间 (CI)：0.67 至 0.71]），但男性死亡率仅降低 16%（HR：0.84 [95% CI：0.82 至 0.71]）。 0.85]）。在控制合并症的多变量分析中，LBBB 与女性死亡率降低 26% 相关（HR：0.74 [95% CI：0.71 至 0.77]），与男性死亡率降低 15% 相关（HR：0.85 [95% CI：0.83 至 0.87]）。性别和 LBBB 之间存在显着的交互作用 (p < 0.0001)。结论 LBBB 诊断与接受 CRT-D 的女性比男性的生存率更高相关，并且这种差异不能用测量的合并症的差异来解释。对于这种差异的可能解释包括，LBBB 根据性别可能具有不同的预后意义，或者与女性相比，男性的 LBBB 诊断更容易出现假阳性。 (c) 2013 年，美国心脏病学会基金会
Objectives The goal of this study was to test the hypothesis that in recipients of cardiac resynchronization therapy defibrillators (CRT-D), conventional left bundle branch block (LBBB) diagnosis predicts better survival in women than in men.Background New York Heart Association class I and II patients without LBBB do not benefit from CRT-D, and women have better survival after CRT-D than men. Separate analysis suggests that QRS duration thresholds for LBBB diagnosis differ according to sex, and conventional LBBB electrocardiographic criteria are falsely positive in men more frequently than in women.Methods We analyzed Medicare records from 144,642 CRT-D recipients between 2002 and 2008 that were followed up for up to 90 months. Medicare billing data were used to determine age, sex, race, and comorbidities. Hazard ratios (HRs) were calculated to assess if conventional LBBB diagnosis had different prognostic significance according to sex.Results In univariate analysis, LBBB was associated with a 31% reduction in death in women (HR: 0.69 [95% confidence interval (CI): 0.67 to 0.71]) but only a 16% reduction in death in men (HR: 0.84 [95% CI: 0.82 to 0.85]). In multivariable analyses controlling for comorbidities, LBBB was associated with a 26% reduction in death in women (HR: 0.74 [95% CI: 0.71 to 0.77]) and a 15% reduction in death in men (HR: 0.85 [95% CI: 0.83 to 0.87]). A significant interaction (p < 0.0001) between sex and LBBB was seen.Conclusions LBBB diagnosis is associated with greater survival in women than in men receiving CRT-D, and this discrepancy is not explained by differences in measured comorbidities. Possible explanations for this difference include that LBBB may have different prognostic significance according to sex or that LBBB diagnosis is more often false-positive in men compared with women. (c) 2013 by the American College of Cardiology Foundation