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Cardiovascular highlights from non-cardiology journals

CARDIAC RESYNCHRONIZATION THERAPY IN WOMEN—EVEN MORE BENEFIT THAN FOR MEN? Women have been under-represented in previous clinic trials evaluating Cardiac Resynchronization Therapy (CRT). As a result, previous studies are underpowered to evaluate the benefit or harm of CRT in this sub-population. This study pooled patient-level data from the 3 trials that compared CRT-defibrillators (CRT-D) versus an implantable cardioverter defibrillator (ICD) alone to compare outcomes in women relative to men. The primary outcome of the study was time to heart failure or death. Given the potential for differences in CRT-D effects across trials, the analysis was completed using a mixed effects Cox proportional hazards with interaction on gender. Of 4076 patients were included in the pooled analysis, 878 (22%) were women. Compared with men, women were more likely to have a left bundle branch block (LBBB) (85% vs 68%) and less likely to have ischemic cardiomyopathy (33% vs 57%). In women, CRT-D was associated with a 60% relative reduction in heart failure or death compared to ICD alone (hazard ratio 0.40; absolute difference 15%) and this was significantly greater than the relative reduction of CRT-D compared to ICD in men (P for interaction 0.002). Furthermore, CRT-D was associated with benefit in women with LBBB and a QRS duration of <150 ms while the benefit of CRT-D in men was limited to patients with LBBB and a QRS≥150 ms.