Gender differences in survival in patients with severe left ventricular dysfunction despite similar extent of myocardial scar measured on cardiac magnetic resonance.
OBJECTIVE
We sought to determine the association between myocardial scarring, gender, and survival in patients with significant coronary artery disease (CAD) and severe systolic left ventricular (LV) dysfunction using delayed hyper-enhancement cardiac magnetic resonance imaging (DHE-CMR).


RESULTS
We studied 339 patients (24% women, mean age 65 +/- 11 years) referred for assessment of myocardial viability by DHE-CMR. Scar was defined as myocardium with an intensity >2 SD above viable myocardium. Left ventricular scar (defined as a percentage of total LV myocardium), LV volumes, risk factors, cardiac transplantation (CTx), and all-cause mortality were recorded. There were 84 deaths and five CTx over 3.7 +/- 1.6 years (median 4 years, interquartile range 2.6-4.9 years). Left ventricular ejection fraction (LVEF) in men was only slightly different from women (23% +/- 9 vs. 25% +/- 10, P = 0.05), whereas mean scar % was similar in both groups (32 +/- 21 vs. 29 +/- 20, P = 0.3). On univariable survival analysis, age [hazard ratio, HR, 1.03 (1.01-1.05), P = 0.002], female gender [HR 2.02 (1.31-3.12), P = 0.001], and scar % [HR 1.01 (1.003-1.02), P = 0.009] predicted outcomes; and also on multivariable analysis (chi(2) 32, P < 0.0001). Women with scar % greater than the median had more events, compared with men with or without a high scar burden (log-rank P < 0.001).


CONCLUSIONS
In patients with CAD and severely reduced LVEF, women have worse outcomes than men, irrespective of myocardial scar burden.
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
Deborah H
DH
Kwon
Carmel M
CM
Halley
Zoran B
ZB
Popovic
Thomas P
TP
Carrigan
Victoria
V
Zysek
Randolph
R
Setser
Paul
P
Schoenhagen
Scott D
SD
Flamm
Randall C
RC
Starling
Milind Y
MY
Desai
D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D002423:Cause of Death; D002921:Cicatrix / Q000473:pathology; D015331:Cohort Studies; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007089:Image Enhancement; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009206:Myocardium / Q000473:pathology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy