title: Effect of Gender on the Risk of Neurologic Events and Subsequent Outcomes in Patients With Left Ventricular Assist Devices.
abstract: Previous studies have shown that women with continuous-flow left ventricular assist devices (LVADs) are at greater risk of neurologic events. However, the relation between neurologic events and subsequent outcomes by gender is not well understood. We aimed to identify gender differences in the risk of neurologic events in patients with LVAD and the impact of time-dependent neurologic event on all-cause mortality by gender. Our study included 34 women and 157 men who received a HeartMate II LVAD at the University of Rochester Medical Center, Rochester, New York, from May 5, 2008, to June 5, 2014. Neurologic event was defined as a transient ischemic attack or cerebrovascular accident (hemorrhagic or ischemic). During a median follow-up of 25 months, 16 women (47%) and 20 men (13%) had neurologic events. Among patients with neurologic events, 7 women (44%) and 9 men (45%) died. Women had a 4.67-fold greater risk of neurologic events (hazard ratio [HR] 4.67, 95% confidence interval [CI] 2.26 to 9.66, p <0.001) compared with men. Women with neurologic events had an increased risk of all-cause mortality compared to women without neurologic event (HR 4.84, 95% CI 1.33 to 17.55, p = 0.017). Similarly, men with neurologic events had an increased risk of all-cause mortality compared to men without neurologic event (HR 4.20, 95% CI 1.93 to 9.17, p <0.001, interaction p = 0.854). In conclusion, among patients with LVAD, women are at greater risk of neurologic event compared to men. Both women and men after LVAD have similar high risk of all-cause mortality after neurologic events.
authors.affiliation: Cardiology Division, University of Rochester School of Medicine and Dentistry, Rochester, New York. Electronic address: Saadia_sherazi@urmc.rochester.edu.
authors.forename: Saadia
authors.initials: S
authors.lastname: Sherazi
authors.affiliation: Cardiology Division, University of Rochester School of Medicine and Dentistry, Rochester, New York.
authors.forename: Valentina
authors.initials: V
authors.lastname: Kutyifa
authors.affiliation: Cardiology Division, University of Rochester School of Medicine and Dentistry, Rochester, New York.
authors.forename: Scott
authors.initials: S
authors.lastname: McNitt
authors.affiliation: Cardiology Division, University of Rochester School of Medicine and Dentistry, Rochester, New York.
authors.forename: Anna
authors.initials: A
authors.lastname: Papernov
authors.affiliation: Cardiology Division, University of Rochester School of Medicine and Dentistry, Rochester, New York.
authors.forename: William
authors.initials: W
authors.lastname: Hallinan
authors.affiliation: Cardiology Division, University of Rochester School of Medicine and Dentistry, Rochester, New York.
authors.forename: Leway
authors.initials: L
authors.lastname: Chen
authors.affiliation: Cardiology Division, University of Rochester School of Medicine and Dentistry, Rochester, New York.
authors.forename: Eugene
authors.initials: E
authors.lastname: Storozynsky
authors.affiliation: Department of Biostatistics, University of Rochester School of Medicine and Dentistry, Rochester, New York.
authors.forename: Brent A
authors.initials: BA
authors.lastname: Johnson
authors.affiliation: Department of Biostatistics, University of Rochester School of Medicine and Dentistry, Rochester, New York.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Strawderman
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky.
authors.forename: H Todd
authors.initials: HT
authors.lastname: Massey
authors.affiliation: Cardiology Division, University of Rochester School of Medicine and Dentistry, Rochester, New York.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Zareba
authors.affiliation: Cardiology Division, University of Rochester School of Medicine and Dentistry, Rochester, New York.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Alexis
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000401:mortality / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D015994:Incidence; D002546:Ischemic Attack, Transient / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology*; D015996:Survival Rate