title: More favorable response to cardiac resynchronization therapy in women than in men.
abstract: BACKGROUND
  Data on sex difference in response to cardiac resynchronization therapy (CRT) remain controversial. We conducted a meta-analysis to summarize all published studies to determine whether sex-based differences in response to CRT exist.
  
  
  RESULTS
  We performed a literature search using MEDLINE (source PubMed; January 1966 to March 2014) and EMBASE (January 1980 to March 2014) with no restrictions. Pooled effect estimates were obtained by using random-effects meta-analysis. Seventy-two studies involving 33 434 patients were identified. Overall, female patients had better outcomes from CRT compared with male patients, with a significant 33% reduction in the risk of death from any cause (hazard ratio, 0.67; 95% confidence interval, 0.61-0.74; P<0.001), 20% reduction in death or hospitalization for heart failure (hazard ratio, 0.80; 95% confidence interval, 0.71-0.90; P<0.001), 41% reduction in cardiac death (hazard ratio, 0.59; 95% confidence interval, 0.42-0.84; P<0.001), and 41% reduction in ventricular arrhythmias or sudden cardiac death (hazard ratio, 0.59; 95% confidence interval, 0.49-0.70; P<0.001). These more favorable responses to CRT in women were consistently associated with greater echocardiographic evidence of reverse cardiac remodeling in women than in men.
  
  
  CONCLUSIONS
  Women obtained greater reductions in the risk of death from any cause, cardiac cause, death or hospitalization for heart failure, and ventricular arrhythmias or sudden cardiac death with CRT therapy compared with men, with consistently greater echocardiographic evidence of reverse cardiac remodeling in women than in men. Further studies are needed to investigate the exact reasons for these results and determine whether indications for CRT in women should be different from men.
authors.affiliation: From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.).
authors.forename: Yun-Jiu
authors.initials: YJ
authors.lastname: Cheng
authors.affiliation: From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.).
authors.forename: Jing
authors.initials: J
authors.lastname: Zhang
authors.affiliation: From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.).
authors.forename: Wei-Jie
authors.initials: WJ
authors.lastname: Li
authors.affiliation: From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.).
authors.forename: Xiao-Xiong
authors.initials: XX
authors.lastname: Lin
authors.affiliation: From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.).
authors.forename: Wu-Tao
authors.initials: WT
authors.lastname: Zeng
authors.affiliation: From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.).
authors.forename: Kai
authors.initials: K
authors.lastname: Tang
authors.affiliation: From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.).
authors.forename: An-li
authors.initials: AL
authors.lastname: Tang
authors.affiliation: From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.).
authors.forename: Jian-Gui
authors.initials: JG
authors.lastname: He
authors.affiliation: From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.).
authors.forename: Qing
authors.initials: Q
authors.lastname: Xu
authors.affiliation: From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.).
authors.forename: Mei-Yi
authors.initials: MY
authors.lastname: Mei
authors.affiliation: From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.).
authors.forename: Dong-Dan
authors.initials: DD
authors.lastname: Zheng
authors.affiliation: From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.).
authors.forename: Yu-Gang
authors.initials: YG
authors.lastname: Dong
authors.affiliation: From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.).
authors.forename: Hong
authors.initials: H
authors.lastname: Ma
authors.affiliation: From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.). wusuhua@hotmail.com.
authors.forename: Su-Hua
authors.initials: SH
authors.lastname: Wu
mesh_terms: D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects / Q000401:mortality; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D016017:Odds Ratio; D020127:Recovery of Function; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome; D020257:Ventricular Remodeling
keywords: cardiac resynchronization therapy; meta-analysis; mortality; sex characteristics