Predictors Of Continuing Improvement After 1st Month Of Crt Implantation In Women With Heart Failure (Hf)

Abstract

Background: Women have been under-represented in major randomized resynchronization clinical trials and constitute 13-31%. Previous studies show greater benefit of CRT in non-ischemic cardiomyopathy.

Objective: We aim to investigate the improvement in cardiac function and performance at 3 different time points after implantation of a CRT device in women.

Methods: We reviewed 200 CRT devices implanted in women between 2004 and 2016 receiving multidisciplinary care in Massachusetts General Hospital. Patient functionality assessment was performed using surrogates of cardiac function: LVEF, NYHA class, Six-minute walk, Minnesota living with heart failure questionnaire (MLHFQ).

Results: A multivariate regression model did not show any independent association with favorable cardiac remodeling or functionality assessment improvement during the 1st month of CRT in women. However, our analysis showed that women without COPD (p=0.015) and with non-ischemic type of cardiomyopathy (p=0.009) present with excellent response after the 1st month of CRT. They presented an increase of 34% in distance covered during the 6-minute walk test, (3% decline for those with ischemic HF) and an average decrease of 0,4 in their NYHA classification system (0.1 decrease for those with ischemic HF). These results were significant for the 6 min walk (R2= 0.3869) and marginally significant for LVEF and NYHA status. Age, hypertension and atrial fibrillation were not associated with poor response.

Conclusion: Women with non-ischemic cardiomyopathy and absence of COPD keep improving after the 1st month of implantation, while ischemic and COPD patients tend to decline or stabilize depending on the surrogate.

Aris Paschalidis

Medical Student

My research interests include health analytics, infectious diseases, and artificial intelligence.