title: Women with nonischemic cardiomyopathy have a favorable prognosis and a better left ventricular remodeling than men after cardiac resynchronization therapy.
abstract: OBJECTIVE
  Cardiac resynchronization therapy (CRT) is a well established therapy in heart failure patients who are on optimal medical therapy and have reduced left ventricular ejection fraction (LVEF) and wide QRS complexes. Although women and patients with nonischemic cardiomyopathy are under-represented in CRT trials and registries, there is evidence that these two groups of patients can benefit more from CRT. The aim of our analysis was to investigate the impact of female sex on mortality in a population that included a high percentage of patients (61%) with nonischemic cardiomyopathy.
  
  
  METHODS
  We analyzed data on 507 consecutive patients (20% women) who received CRT at two Italian Heart Transplant centers and were followed up for a maximum of 48 months.
  
  
  RESULTS
  After multivariate adjustment, women showed a trend toward better survival with regard to all-cause mortality [hazard ratio (HR) 0.32, confidence interval (CI) 0.10-1.04; P = 0.059]. However, this benefit was limited to nonischemic patients with regard to all-cause mortality (HR 0.20, CI 0.05-0.87, P = 0.032) and cardiovascular mortality (HR 0.14, CI 0.02-1.05, P = 0.056).
  
  
  CONCLUSIONS
  Female CRT recipients, at mid-term, have a favorable prognosis than male patients and this benefit appears to be more evident in nonischemic patients. Thus, we strongly believe that the apparent under-utilization of CRT in females is an anomaly that should be corrected.
authors.affiliation: a'A De Gasperis' Cardiac Department, Niguarda Ca' Granda, Granda Hospital, Milan bCardiac Department, Policlinico San Matteo, Pavia cMedtronic Clinical Research Institute dMedtronic Italia S.p.A., Milano, Italy.
authors.forename: Manlio
authors.initials: M
authors.lastname: Cipriani
authors.forename: Maurizio
authors.initials: M
authors.lastname: Landolina
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Oliva
authors.forename: Stefano
authors.initials: S
authors.lastname: Ghio
authors.forename: Sara
authors.initials: S
authors.lastname: Vargiu
authors.forename: Roberto
authors.initials: R
authors.lastname: Rordorf
authors.forename: Claudia
authors.initials: C
authors.lastname: Raineri
authors.forename: Enrico
authors.initials: E
authors.lastname: Ammirati
authors.forename: Barbara
authors.initials: B
authors.lastname: Petracci
authors.forename: Claudia
authors.initials: C
authors.lastname: Campo
authors.forename: Silvia
authors.initials: S
authors.lastname: Bisetti
authors.forename: Maurizio
authors.initials: M
authors.lastname: Lunati
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D009202:Cardiomyopathies / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D017147:Defibrillators, Implantable; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012737:Sex Factors; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome; D020257:Ventricular Remodeling / Q000502:physiology*