title: Sex-specific mortality risk by QRS morphology and duration in patients receiving CRT: results from the NCDR.
abstract: BACKGROUND
  Prior studies have suggested that women have better outcomes than men after cardiac resynchronization therapy-defibrillator (CRT-D) implantation.
  
  
  OBJECTIVE
  The purpose of this study was to compare mortality after CRT-D implantation by sex, QRS morphology, and duration.
  
  
  METHODS
  Survival curves and covariate adjusted hazard ratios (HR) were used to assess mortality by sex in 31,892 CRT-D patients in the National Cardiovascular Data Registry (NCDR), implantable cardioverter defibrillator (ICD) registry between 2006 and 2009, with up to 5 years' follow-up (median 2.9 years, interquartile range: 2.0 to 3.9 years). Patients were grouped by QRS morphology and 10-ms increments in QRS duration.
  
  
  RESULTS
  Among patients with left bundle branch block (LBBB), women had a 21% lower mortality risk than men (HR: 0.79; 95% CI: 0.74 to 0.84; p < 0.001); however, there was no sex difference in non-LBBB (HR: 0.95; 95% CI: 0.85 to 1.06; p = 0.37). Longer QRS duration was associated with better survival in both sexes with LBBB, but not in patients without LBBB. Compared with women with LBBB and QRS of 120 to 129 ms, women with LBBB and QRS of 140 to 149 ms had a 27% lower mortality (HR: 0.73; 95% CI: 0.60 to 0.88; p = 0.001); this difference was 18% in men (HR: 0.82; 95% CI: 0.71 to 0.93; p = 0.003). Mortality in LBBB and QRS of 150 ms or longer compared with those with LBBB and QRS of 120 to 129 ms was similar between sexes (HR: 0.61 to 0.68; p < 0.001 for women and HR: 0.58 to 0.66; p < 0.001 for men). Sex interactions within 10-ms groups were not significant.
  
  
  CONCLUSIONS
  Among patients with LBBB who received CRT-D, mortality is lower in women than men. Additionally, longer QRS duration in LBBB is associated with better survival in both sexes. In contrast, there is no sex difference in patients without LBBB, regardless of QRS duration. Further studies should include a non-CRT comparator group to confirm these findings.
authors.affiliation: Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland.
authors.forename: Robbert
authors.initials: R
authors.lastname: Zusterzeel
authors.affiliation: Yale School of Medicine, New Haven, Connecticut.
authors.forename: Jeptha P
authors.initials: JP
authors.lastname: Curtis
authors.affiliation: Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Caños
authors.affiliation: Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland.
authors.forename: William E
authors.initials: WE
authors.lastname: Sanders
authors.affiliation: Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Selzman
authors.affiliation: Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland.
authors.forename: Ileana L
authors.initials: IL
authors.lastname: Piña
authors.affiliation: Yale School of Medicine, New Haven, Connecticut.
authors.forename: Erica S
authors.initials: ES
authors.lastname: Spatz
authors.affiliation: Yale School of Medicine, New Haven, Connecticut.
authors.forename: Haikun
authors.initials: H
authors.lastname: Bao
authors.affiliation: American College of Cardiology Foundation, Washington, DC.
authors.forename: Angelo
authors.initials: A
authors.lastname: Ponirakis
authors.affiliation: VA Eastern Colorado Health Care System, University of Colorado, and the Colorado Cardiovascular Outcomes Research Group, Denver, Colorado.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Varosy
authors.affiliation: University of Colorado Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Masoudi
authors.affiliation: Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland. Electronic address: david.strauss@fda.hhs.gov.
authors.forename: David G
authors.initials: DG
authors.lastname: Strauss
mesh_terms: D000368:Aged; D002037:Bundle-Branch Block / Q000150:complications; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D017147:Defibrillators, Implantable; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D015203:Reproducibility of Results; D012306:Risk; D012737:Sex Factors; D016896:Treatment Outcome; D014481:United States
keywords: QRS duration; QRS morphology; cardiac resynchronization therapy; men; women