The interaction of sex, height, and QRS duration on the effects of cardiac resynchronization therapy on morbidity and mortality: an individual-patient data meta-analysis
OA Location
Author(s)
Type
Journal Article
Abstract
AIMS: To explore possible associations that may explain the greater benefit from cardiac resynchronization therapy (CRT) reported amongst women. METHODS AND RESULTS: In an individual-patient data meta-analysis of five randomized controlled trials, all-cause mortality and the composite of all-cause mortality or first hospitalization for heart failure (HF) were compared among 794 women and 2702 men assigned to CRT or a control group. Multivariable analyses were performed to assess the impact of sex, QRS duration, HF aetiology, left ventricular end-diastolic diameter (LVEDD), and height on outcome. Women were shorter, had smaller LVEDD, more often left bundle branch block, and less often ischaemic heart disease, but QRS duration was similar between sexes. Women tended to obtain greater benefit from CRT but sex was not an independent predictor of either outcome. For all-cause mortality, QRS duration was the only independent predictor of CRT benefit. For the composite outcome, height and QRS duration, but not sex, were independent predictors of CRT benefit. Further analysis suggested increasing benefit with increasing QRS duration amongst shorter patients, of whom a great proportion were women. CONCLUSIONS: In this individual-patient data meta-analysis, CRT benefit was greater in shorter patients, which may explain reports of enhanced CRT benefit among women. Further analyses are required to determine whether recommendations on the QRS threshold for CRT should be adjusted for height. (ClinicalTrials.gov numbers: NCT00170300, NCT00271154, NCT00251251).
Date Issued
2018-01-04
Date Acceptance
2017-12-04
Citation
European Journal of Heart Failure, 2018, 20 (4), pp.780-791
ISSN
1388-9842
Publisher
Wiley
Start Page
780
End Page
791
Journal / Book Title
European Journal of Heart Failure
Volume
20
Issue
4
Copyright Statement
© 2018 The Authors. European Journal of Heart Failure © 2018 European Society of Cardiology
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/29314424
Subjects
Cardiac resynchronization therapy
Gender
Heart failure
Height
Publication Status
Published online
Coverage Spatial
England