Heart and Vascular Institute at the Cleveland Clinic, OH. Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, OH.
Circulation. 2019 Feb 19;139(8):1080-1093. doi: 10.1161/CIRCULATIONAHA.118.037369.
This in-depth review of sex differences in advanced heart failure therapy summarizes the existing literature on implantable cardioverter defibrillators, biventricular pacemakers, mechanical circulatory support, and transplantation with a focus on utilization, efficacy/clinical effectiveness, adverse events, and controversies. One will learn about the controversies regarding efficacy/clinical effectiveness of implantable cardioverter defibrillators and understand why these devices should be implanted in women even if there are sex differences in appropriate shocks. Individuals will learn about the sex differences with biventricular pacemakers with respect to ventricular remodeling and reduction in heart failure hospitalizations/mortality, as well as, possible mechanisms. We will demonstrate sex differences in heart transplantation and waitlist survival. Despite similar survival for women and men with left ventricular assist devices, there are sex differences in adverse events. These devices do successfully bridge women and men to transplant, yet women are less likely than men to have a left ventricular assist at time of listing and time of transplantation. Finally, one will learn about the concerns regarding poor outcome for men who receive female donor hearts and discover this may not be due to sex, but rather size. More research is needed to better understand sex differences and further improve advanced heart failure therapy for both women and men.
这篇深入探讨心力衰竭晚期治疗中性别差异的综述总结了有关植入式心脏复律除颤器、双心室起搏器、机械循环支持和移植的现有文献，重点关注了这些治疗方法的应用、疗效/临床效果、不良事件和争议。读者将了解到关于植入式心脏复律除颤器疗效/临床效果的争议，并明白为何即便电击存在性别差异，这些设备仍应植入女性体内。此外，读者还将了解到双心室起搏器在心室重构和心力衰竭住院/死亡率降低方面的性别差异，以及可能的机制。我们将展示心脏移植和候补名单存活率方面的性别差异。尽管女性和男性在使用左心室辅助装置后的生存率相似，但在不良事件方面仍存在性别差异。这些设备确实成功地将女性和男性桥接至移植，但与男性相比，女性在候补名单和移植时更不可能使用左心室辅助装置。最后，读者将了解到有关男性接受女性供体心脏后预后不佳的担忧，并发现这可能不是由于性别，而是由于心脏大小的差异。需要进一步研究以更好地了解性别差异，并进一步改善女性和男性的心力衰竭晚期治疗。
