Sex-Related Procedural Aspects and Complications in CRT Survey II

Auricchio, Angelo; Gasparini, Maurizio; Linde, Cecilia; Dobreanu, Dan; Cano, Óscar; Sterliński, Maciej; Bogale, Nigussie; Stellbrink, Christoph; Refaat, Marwan M.; Blomström‐Lundqvist, Carina; Lober, Christiane; Dickstein, Kenneth; Normand, Camilla

doi:10.1016/j.jacep.2019.06.003

Cited by 18 publications

(14 citation statements)

References 19 publications

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“…In another publication from CRT Survey II we demonstrated that female patients more often experienced intra-and periprocedural complications such as pneumothorax, pericardial tamponade, coronary sinus dissection and lead dislodgment. 69 The low percentage of women implanted with a CRT can partially be explained by the fact that women develop heart failure at older age than men. Women are also more likely to develop HF with persevered ejection fraction than heart failure with reduced ejection fraction and thereby not quality for a CRT.…”

Section: Crt In Womenmentioning

confidence: 99%

Adherence to ESC cardiac resynchronization therapy guidelines: findings from the ESC CRT Survey II

et al. 2020

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Aims Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in patients with heart failure (HF) and electrical dyssynchrony. The European Society of Cardiology (ESC) Guidelines provide evidence-based recommendations indicating optimal patient selection for CRT implantation in both the 2013 European Heart Rhythm Association (EHRA) and the 2016 Heart Failure Association (HFA) Guidelines. We assessed the adherence to guidelines and identified factors associated with guideline adherence. Methods and results In 2016, the HFA and EHRA conducted the CRT Survey II in 42 ESC countries. The data collected were sufficient to evaluate adherence to guidelines in 8021 patients. Of these, 67% had a Class I guideline indication for CRT implantation, which was significantly correlated with female gender (1.70, P < 0.0001), age <75 years (1.55, P < 0.0001), non-ischaemic HF aetiology (1.22, P < 0.0001), and elective admission (1.87, P < 0.0001). A further 26% of implants had a Class IIa indication, 5% IIb and only 2% a contraindication to CRT—a Class III indication. Patients implanted under Level IIa indications were much more likely to have more comorbidities than patients implanted under Level I indications. However, there were large variations in guideline adherence between ESC countries. Conclusion Implanters in ESC member states demonstrate a high degree of adherence to ESC guidelines with 98% of implants having a documented Class I, IIa or IIb indication. Cardiac resynchronization therapy implantation without a Class I indication was more likely in men, patients age ≥75 years, with HF of ischaemic origin and in patients admitted to hospital acutely.

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Section: Crt In Womenmentioning

confidence: 99%

Adherence to ESC cardiac resynchronization therapy guidelines: findings from the ESC CRT Survey II

et al. 2020

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“…According to the results of the SMART-AV trial, the optimization of atrioventricular delay intervals is associated with improved outcomes in women but not in men (41), which might be attributable to the inherent sex-related differences in atrial geometry and PR intervals. A higher percentage of biventricular pacing has also been reported in women (29,41,42), most probably due to the lower rate of atrial fibrillation compared to men (43,44). This could also contribute to the observed differences in mortality between sexes as even a small increment in the biventricular pacing rate may improve outcomes (45).…”

Section: Sex-specific Differences In Outcomes Following Crt Implantationmentioning

confidence: 96%

Sex-Specific Patterns of Mortality Predictors Among Patients Undergoing Cardiac Resynchronization Therapy: A Machine Learning Approach

Tokodi

Behon

Merkel

et al. 2021

Front. Cardiovasc. Med.

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Background: The relative importance of variables explaining sex-related differences in outcomes is scarcely explored in patients undergoing cardiac resynchronization therapy (CRT). We sought to implement and evaluate machine learning (ML) algorithms for the prediction of 1- and 3-year all-cause mortality in CRT patients. We also aimed to assess the sex-specific differences in predictors of mortality utilizing ML.Methods: Using a retrospective registry of 2,191 CRT patients, ML models were implemented in 6 partially overlapping patient subsets (all patients, females, or males with 1- or 3-year follow-up). Each cohort was randomly split into training (80%) and test sets (20%). After hyperparameter tuning in the training sets, the best performing algorithm was evaluated in the test sets. Model discrimination was quantified using the area under the receiver-operating characteristic curves (AUC). The most important predictors were identified using the permutation feature importances method.Results: Conditional inference random forest exhibited the best performance with AUCs of 0.728 (0.645–0.802) and 0.732 (0.681–0.784) for the prediction of 1- and 3-year mortality, respectively. Etiology of heart failure, NYHA class, left ventricular ejection fraction, and QRS morphology had higher predictive power, whereas hemoglobin was less important in females compared to males. The importance of atrial fibrillation and age increased, while the importance of serum creatinine decreased from 1- to 3-year follow-up in both sexes.Conclusions: Using ML techniques in combination with easily obtainable clinical features, our models effectively predicted 1- and 3-year all-cause mortality in CRT patients. Sex-specific patterns of predictors were identified, showing a dynamic variation over time.

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“…An analysis of procedural data from the European Society of Cardiology CRT Survey II showed that females have a higher rate of periprocedural complications with CRT-pacemaker or CRT-D therapy, primarily driven by higher rates of pneumothorax, coronary sinus dissection, and pericardial tamponade. 143…”

Section: Cardiac Resynchronization Therapy and Pacing In Womenmentioning

confidence: 99%

Arrhythmias in Female Patients: Incidence, Presentation and Management

Zeitler

Poole

Chen

et al. 2022

Circulation Research

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There is a growing appreciation for differences in epidemiology, treatment, and outcomes of cardiovascular conditions by sex. Historically, cardiovascular clinical trials have under-represented females, but findings have nonetheless been applied to clinical care in a sex-agnostic manner. Thus, much of the collective knowledge about sex-specific cardiovascular outcomes result from post hoc and secondary analyses. In some cases, these investigations have revealed important sex-based differences with implications for optimizing care for female patients with arrhythmias. This review explores the available evidence related to cardiac arrhythmia care among females, with emphasis on areas in which important sex differences are known or suggested. Considerations related to improving female enrollment in clinical trials as a way to establish more robust clinical evidence for the treatment of females are discussed. Areas of remaining evidence gaps are provided, and recommendations for areas of future research and specific action items are suggested. The overarching goal is to improve appreciation for sex-based differences in cardiac arrhythmia care as 1 component of a comprehensive plan to optimize arrhythmia care for all patients.

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Sex-Related Procedural Aspects and Complications in CRT Survey II

Cited by 18 publications

References 19 publications

Adherence to ESC cardiac resynchronization therapy guidelines: findings from the ESC CRT Survey II

Adherence to ESC cardiac resynchronization therapy guidelines: findings from the ESC CRT Survey II

Sex-Specific Patterns of Mortality Predictors Among Patients Undergoing Cardiac Resynchronization Therapy: A Machine Learning Approach

Arrhythmias in Female Patients: Incidence, Presentation and Management

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