在使用或不使用植入式心脏复律除颤器的心脏再同步治疗中，性别差异日益增大。
Increasing sex differences in the use of cardiac resynchronization therapy with or without implantable cardioverter-defibrillator.
作者信息
Chatterjee Neal A, Borgquist Rasmus, Chang Yuchiao, Lewey Jennifer, Jackson Vicki A, Singh Jagmeet P, Metlay Joshua P, Lindvall Charlotta
机构信息
Cardiac Arrhythmia Service and Division of Cardiology, GRB 109, Massachusetts General Hospital Heart Center, 55 Fruit Street, Boston, MA 02114, USA.
Department of Cardiology, Lund University, Skane University Hospital, SE-221 85, Lund, Sweden.
出版信息
Eur Heart J. 2017 May 14;38(19):1485-1494. doi: 10.1093/eurheartj/ehw598.
AIMS
Previous studies have identified sex disparities in the use of cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillators (ICD), although the basis of underutilization in women remains poorly understood. The aim of this study was to assess sex differences in patterns of CRT use with our without ICD.
METHODS AND RESULTS
In this cross-sectional study using the National Inpatient Sample database we identified 311 009 patients undergoing CRT implantation in the United States between 2006 and 2012. Demographic and clinical characteristics were compared between men and women undergoing CRT implantation, with special attention to clinical predictors of left ventricular reverse remodelling (CRT response, score range: 0-4) and reduced ICD efficacy (score range: 0-7). When compared to men, women undergoing CRT implantation were significantly more likely to have ≥ 3 predictors of CRT response (47.3 vs. 33.2%, P < 0.001) and less likely to have ≥3 predictors of reduced ICD efficacy (27.0 vs. 37.3%, P < 0.001). Despite this, men were significantly more likely to undergo CRT with ICD (CRT-D) as the type of CRT (88.6 vs. 80.1% of all CRT implants). Compared to those with the greatest likelihood of CRT response (score ≥ 3), those with the least likelihood of CRT response had a significant decreased odds of CRT-D implant (adj odds ratio 0.27 [0.24-0.31], P < 0.001), with a greater decreased odds in women compared to men (P, for sex interaction <0.001). The difference in the % of CRT-D implant in men vs. women increased over the study period (P, sex Δ time trend = 0.012).
CONCLUSION
In this large, contemporary cohort, sex differences in CRT-D implantation were inversely related to predicted CRT efficacy and have increased over time. Future efforts to narrow the gap in CRT-D implantation in men and women may help better align device selection with those most likely to benefit.
目的
既往研究已确定在心脏再同步治疗（CRT）和植入式心脏复律除颤器（ICD）的使用方面存在性别差异，尽管女性使用不足的原因仍知之甚少。本研究的目的是评估使用或未使用ICD的CRT使用模式中的性别差异。
方法与结果
在这项使用国家住院样本数据库的横断面研究中，我们确定了2006年至2012年期间在美国接受CRT植入的311009例患者。比较了接受CRT植入的男性和女性的人口统计学和临床特征，特别关注左心室逆向重构（CRT反应，评分范围：0 - 4）和ICD疗效降低（评分范围：0 - 7）的临床预测因素。与男性相比，接受CRT植入的女性更有可能有≥3个CRT反应预测因素（47.3%对33.2%，P < 0.001），且有≥3个ICD疗效降低预测因素的可能性更小（27.0%对37.3%，P < 0.001）。尽管如此，男性接受CRT并植入ICD（CRT-D）作为CRT类型的可能性显著更高（占所有CRT植入的88.6%对80.1%）。与CRT反应可能性最大（评分≥3）的患者相比，CRT反应可能性最小的患者植入CRT-D的几率显著降低（调整后的优势比为0.27 [0.24 - 0.31]，P < 0.001），女性相比于男性降低的几率更大（性别交互作用的P < 0.001）。在研究期间，男性与女性CRT-D植入百分比的差异有所增加（P，性别×时间趋势 = 0.012）。
结论
在这个大型当代队列中，CRT-D植入的性别差异与预测的CRT疗效呈负相关，且随时间增加。未来缩小男性和女性CRT-D植入差距的努力可能有助于使设备选择更好地与最可能受益的人群相匹配。
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