title: Cardiac resynchronization therapy is more effective in women than in men: the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy) trial.
abstract: OBJECTIVE
  The purpose of this study was to investigate the factors related to sex-specific outcomes for death and heart failure events in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy) trial.
  
  
  BACKGROUND
  In the MADIT-CRT trial, women seemed to achieve a better result from resynchronization therapy than men.
  
  
  METHODS
  All 1,820 patients (453 female and 1,367 male) enrolled in the MADIT-CRT trial were included in this sex-specific outcome analysis that compared the effect of cardiac resynchronization therapy with defibrillator (CRT-D) relative to implanted cardioverter-defibrillator (ICD) on death or heart failure (whichever came first), heart failure only, and death at any time.
  
  
  RESULTS
  Female patients were more likely to have nonischemic cardiomyopathy and left bundle branch block and less likely to have renal dysfunction than male patients. Overall, female patients had a better result from CRT-D therapy than male patients, with a significant 69% reduction in death or heart failure (hazard ratio: 0.31, p < 0.001) and 70% reduction in heart failure alone (hazard ratio: 0.30, p < 0.001). Women had a significant 72% reduction in all-cause mortality in the total population (hazard ratio: 0.28, p = 0.02) and significant 82% and 78% reductions in mortality in those with QRS ≥ 150 ms and with left bundle branch block conduction disturbance, respectively, with sex-by-treatment interactions for mortality reduction significant at p < 0.05 in each of these 3 patient groups. These beneficial CRT-D effects among women were associated with consistently greater echocardiographic evidence of reverse cardiac remodeling in women than in men.
  
  
  CONCLUSIONS
  Women in the MADIT-CRT trial obtained significantly greater reductions in death or heart failure (whichever came first), heart failure alone, and all-cause mortality with CRT-D therapy than men, with consistently greater echocardiographic evidence of reverse cardiac remodeling in women than in men. (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy [MADIT-CRT]; NCT00180271).
authors.affiliation: Cardiology Division, St. Luke's and Roosevelt Hospitals and Columbia University, New York, New York, USA.
authors.forename: Aysha
authors.initials: A
authors.lastname: Arshad
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Moss
authors.forename: Elyse
authors.initials: E
authors.lastname: Foster
authors.forename: Luigi
authors.initials: L
authors.lastname: Padeletti
authors.forename: Alon
authors.initials: A
authors.lastname: Barsheshet
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
authors.forename: Henry
authors.initials: H
authors.lastname: Greenberg
authors.forename: W Jackson
authors.initials: WJ
authors.lastname: Hall
authors.forename: Scott
authors.initials: S
authors.lastname: McNitt
authors.forename: Wojciech
authors.initials: W
authors.lastname: Zareba
authors.forename: Scott
authors.initials: S
authors.lastname: Solomon
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Steinberg
mesh_terms: D000368:Aged; D002037:Bundle-Branch Block / Q000150:complications; D058406:Cardiac Resynchronization Therapy; D009202:Cardiomyopathies / Q000150:complications; D017147:Defibrillators, Implantable; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007674:Kidney Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D016896:Treatment Outcome