Heart Size Corrected Electrical Dyssynchrony and Its Impact on Sex-Specific Response to Cardiac Resynchronization Therapy

Odette A. E. Salden*, Antonius M. W. van Stipdonk, Hester M. den Ruijter, Maarten Jan Cramer, Marielle Kloosterman, Michiel Rienstra, Alexander H. Maass, Frits W. Prinzen, Kevin Vernooy, Mathias Meine

*Corresponding author for this work

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Abstract

Background:

Women are less likely to receive cardiac resynchronization therapy, yet, they are more responsive to the therapy and respond at shorter QRS duration. The present study hypothesized that a relatively larger left ventricular (LV) electrical dyssynchrony in smaller hearts contributes to the better cardiac resynchronization therapy response in women. For this, the vectorcardiography-derived QRS area is used, since it allows for a more detailed quantification of electrical dyssynchrony compared with conventional electrocardiographic markers.

Methods:

Data from a multicenter registry of 725 cardiac resynchronization therapy patients (median follow-up, 4.2 years [interquartile range, 2.7-6.1]) were analyzed. Baseline electrical dyssynchrony was evaluated using the QRS area and the corrected QRS area for heart size using the LV end-diastolic volume (QRSarea/LVEDV). Impact of the QRSarea/LVEDV ratio on the association between sex and LV reverse remodeling (LV end-systolic volume change) and sex and the composite outcome of all-cause mortality, LV assist device implantation, or heart transplantation was assessed.

Results:

At baseline, women (n=228) displayed larger electrical dyssynchrony than men (QRS area, 132 +/- 55 versus 123 +/- 58 mu Vs; P=0.043), which was even more pronounced for the QRSarea/LVEDV ratio (0.76 +/- 0.46 versus 0.57 +/- 0.34 mu Vs/mL; P

Conclusions:

Greater electrical dyssynchrony in smaller hearts contributes, in part, to more reverse remodeling observed in women after cardiac resynchronization therapy, but this does not explain their better long-term outcomes.

Original languageEnglish
Article number008452
Number of pages10
JournalCirculation-Arrhythmia and Electrophysiology
Volume14
Issue number1
DOIs
Publication statusPublished - Jan 2021

Keywords

  • cardiac resynchronization therapy
  • electrocardiography
  • heart failure
  • sex
  • vectorcardiography
  • SURVIVAL
  • PREDICTS
  • GUIDELINES
  • FAILURE
  • WOMEN
  • MEN
  • QRS DURATION
  • SELECTION
  • GENDER-DIFFERENCES

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