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• W4377015439 abstract "Prior studies have reported that women are more likely to derive benefit from cardiac resynchronization therapy (CRT), and do so at shorter QRS durations, than men. However, women are generally smaller than men and these differences in response to CRT could be explained by differences in body size. To determine if sex-based differences in CRT are accounted for by differences in body size. We analyzed patient level data from pivotal CRT trials (MIRACLE, MIRACLE-ICD, MIRACLE-ICD II, REVERSE, RAFT, COMPANION, and MADIT-CRT) using adjusted Bayesian Hierarchical Weibull survival regression models to determine if sex differences in CRT benefit are accounted for by commonly used measures of body size: height and body surface area (BSA). Additionally, the continuous relationship between QRS duration and CRT benefit was examined overall and in sex-stratified cohorts; similar analyses were repeated, except that QRS duration was indexed by height (ms/m) or BSA (ms/m2). The endpoint was time to heart failure hospitalization (HFH) or death. Of the 5,628 patients included, 1,439 were women, the median age was 66 years (IQR 58-73), and 62% received CRT. Compared with men, women were shorter (1.62 m, IQR 1.57-1.65 versus 1.75m, IQR 1.70-1.80, p<0.001) and had a smaller BSA (1.76m2, IQR 1.62-1.90 vs. 2.02m2, IQR 1.89-2.16, p<0.001). In sex-stratified analyses, adjusting for baseline characteristics and QRS duration and morphology, women obtained greater benefit from CRT (HR 0.54, CrI 0.42 – 0.70) than did men (HR 0.77, CrI 0.66 – 0.89; pinteraction = 0.009). Results were similar with additional adjustments for height and BSA (Table). CRT benefit was more evident at shorter QRS durations for women compared with men (125 vs. 145ms; Figure). Indexing QRS duration by height attenuated but did not eliminate sex-specific thresholds for CRT benefit (77ms/m for women and 83ms/m for men). Although indexing QRS duration by BSA resulted in very similar thresholds for benefit (70ms/m2 for women, 71ms/m2 for men), the point estimates associated with these thresholds predicted greater magnitude of benefit for women (Figure). Women obtain greater benefit from CRT than men and derive benefit at shorter QRS durations. Although differences in body size may explain sex-specific QRS duration thresholds for CRT benefit, body size does not explain why women derive a greater magnitude of CRT benefit. Indexing QRS duration for BSA may improve patient selection for CRT.Tabled 1CRT effect by sex controlling for QRS duration, height and BSAModelEffect in women (Adjusted HR and 95% CrI)Effect in men (Adjusted HR and 95% CrI)Ratio of HRs and 95% CrI (Mens/Women)Posterior probability for ratio of HRs ≠ 1Model 10.54, 0.42 – 0.700.77, 0.66 – 0.891.41, 1.11 – 1.830.009Model 20.55, 0.43 – 0.700.77, 0.67 – 0.891.41, 1.08 – 1.820.009All models control for the presence of an ICD and baseline characteristics (age, NYHA class, ejection fraction, QRS morphology, atrial fibrillation, diabetes, hypertension, ischemic etiology, use of beta-blockers, and use of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker). Model 1. Additionally, controlling for QRS duration, but not for height nor BSA. Model 2. Additionally, controlling for QRS duration, height and BSA. Open table in a new tab" @default.
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• W4377015439 date "2023-05-01" @default.
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• W4377015439 title "PO-02-027 RELATIONSHIP BETWEEN SEX, BODY SIZE, AND CRT BENEFIT: A PATIENT LEVEL META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS" @default.
• W4377015439 doi "https://doi.org/10.1016/j.hrthm.2023.03.833" @default.
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