Impact of left atrial volume in prediction of outcome after cardiac resynchronization therapy

Sex Differences in Device Therapy for Heart Failure: Utilization, Outcomes, and Adverse Events

“…10,11,127 Although many of these studies did not evaluate sex differences in patients with LBBB, the higher prevalence of LBBB among women is a potential explanation for differences is CRT response, as it has been shown that response to CRT is better in patients with a LBBB. 19,28 While the MADIT-CRT trial showed this benefit and reported outcomes based on sex and disease etiology, we were not able to compare this to other studies since they did not include analysis by etiology and LBBB.…”

“…81 Nineteen single-armed prospective and retrospective cohort studies found that heart failure hospitalization or death occurred in men more than in women. 28,44,52,79,83,86,87,90,91,93,94,107,111,114,115,117,118 Some studies, however, found that there were no sex differences in mortality and that men were less likely to experience adverse events compared with women, but these findings were not statistically significant. 80,109 Device-related complications Two articles included data on device-related complications.…”

“…103,106 Of these 100 articles, 56 included comparisons of means or risk ratio estimates of effectiveness analyses of improvement in NYHA heart failure class, ejection fraction, and left ventricular volumes. 19,21,24,25,107 Twenty-two articles discussed sex-specific outcomes for hospitalization and death 44,[50][51][52][79][80][81][82][83][84]110 or death alone, 19,28,[85][86][87][88][89][90][91][92][93][94]114,[116][117][118] 2 included device-related complications, 120,121 and 20 included baseline characteristics stratified by sex (Fig. 1).…”

“…19,22,28,44,50,52,[79][80][81]83,[85][86][87][88][89][90][91][92][93][94]107,110,114,118 There were 42 studies that reported CRT heart failure hospitalization or death using hazard ratios; 83% of the outcomes showed a greater benefit in women. More specifically, the Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT-CRT) trial enrolled 1820 heart failure patients randomly assigned (3:2 ratio) to CRT-D (n = 1089) or standard implantable defibrillators (ICD) alone (n = 731).…”

A resynchronized shunt

“…We hypothesize that CRT may have favored atrial shunt inversion via two different mechanisms: 1) a decrease in left atrial pressure, as showed by the considerable reduction in average E/e′ ratio after resynchronization, related to the improvement in both LV diastolic function and mitral regurgitation degree; 2) the effect of pacemaker lead positioning on tricuspid valve dynamics, which may have contributed to the increase in TR by lead impingement of the septal leaflet, thus leading to an increase in right atrial pressure. The potential beneficial effects of CRT on left atrial pressure and volume are well established, and the detection of atrial reverse remodeling after biventricular pacing has been shown to predict improved clinical outcomes [6,7]. On the other hand, worsening of TR is a common finding after cardiac device implantation and can occur via multiple mechanisms, including interference with leaflet closure, direct valve injury, thrombosis, lead adherence to leaflets due to scarring, lead entrapment in the tricuspid valve apparatus, and abnormal, pacemaker-induced RV activation [8].…”