Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Heart Rhythm. 2022 Jul;19(7):1133-1140. doi: 10.1016/j.hrthm.2022.02.027. Epub 2022 Mar 4.
Past studies have shown the sex-related difference in the efficacy of cardiac resynchronization therapy (CRT). However, the data for cardiac sarcoidosis (CS) are limited.
The purpose of this study was to assess the sex-related prognostic differences in CS patients with CRT.
This multicenter CS survey included 430 patients (295 females) who met the diagnostic criteria for CS. Patients were divided into those treated with primary CRT or upgraded CRT from the pacemaker (CRT group; n = 73) and others (control group; n = 357). Sex differences in the incidence of all-cause death, heart failure (HF) death including heart transplantation, ventricular arrhythmia events (VAEs) (sudden death, appropriate device therapy), cardiac adverse events (CAEs) (HF death, VAEs), changes in serum brain natriuretic peptide (BNP) levels, and left ventricular ejection fraction (LVEF) over the follow-up period were analyzed.
During median follow-up of 5.2 years, males, but not females, in the CRT group had significantly worse all-cause mortality than patients in the control group (P <.001). In the CRT group, there was no significant sex-related difference in the incidence of HF death; however, females had significantly better VAE- and CAE-free survival than males (P = .033 and P = .008, respectively). Multivariate analysis of the CRT group showed that female sex (hazard ratio 0.37; 95% confidence interval 0.15-0.89; P = .02 and P = .6) independently predicted freedom from CAEs. During follow-up, BNP levels were significantly improved in all groups. LVEF was maintained in females with CRT.
In CS patients with CRT, HF death-free survival was similar between sexes. However, females exhibited better VAE- and CAE-free survival than males.
过去的研究表明，心脏再同步治疗（CRT）的疗效存在性别差异。然而，关于心脏结节病（CS）的数据有限。
本研究旨在评估 CRT 治疗 CS 患者的性别相关预后差异。
这项多中心 CS 调查纳入了符合 CS 诊断标准的 430 名患者（295 名女性）。患者分为接受初次 CRT 或从起搏器升级为 CRT（CRT 组；n=73）的患者和其他患者（对照组；n=357）。分析了随访期间全因死亡率、心力衰竭（HF）死亡（包括心脏移植）、室性心律失常事件（VAEs）（猝死、适当的器械治疗）、心脏不良事件（CAEs）（HF 死亡、VAEs）、血清脑钠肽（BNP）水平变化和左心室射血分数（LVEF）的发生率在不同性别间的差异。
在中位随访 5.2 年期间，与对照组相比，CRT 组中的男性患者，而非女性患者，全因死亡率显著更高（P<0.001）。在 CRT 组中，HF 死亡的发生率在不同性别间无显著差异；然而，女性患者的 VAEs 和 CAEs 无事件生存率显著优于男性（P=0.033 和 P=0.008）。对 CRT 组进行多变量分析显示，女性性别（风险比 0.37；95%置信区间 0.15-0.89；P=0.02 和 P=0.6）独立预测 CAEs 无事件发生。随访期间，所有组的 BNP 水平均显著改善。CRT 治疗的女性患者的 LVEF 得以维持。
在 CRT 治疗的 CS 患者中，不同性别间 HF 死亡无事件生存率相似。然而，女性患者的 VAEs 和 CAEs 无事件生存率优于男性。
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