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Sex-Specific Outcomes of LBBAP Versus Biventricular Pacing: Results From I-CLAS

FA. Subzposh, PS. Sharma, Ó. Cano, SS. Ponnusamy, B. Herweg, F. Zanon, M. Jastrzebski, J. Zou, MG. Chelu, K. Vernooy, ZI. Whinnett, GM. Nair, M. Molina-Lerma, K. Curila, KA. Ellenbogen, P. Vijayaraman

. 2024 ; 10 (1) : 96-105. [pub] 20230903

Language English Country United States

Document type Multicenter Study, Journal Article

Persistent link   https://www.medvik.cz/link/bmc24007829

Grant support
CS/15/3/31405 British Heart Foundation - United Kingdom

BACKGROUND: Cardiac resynchronization therapy (CRT) using biventricular pacing (BVP) has been associated with greater clinical improvement in women than men. Recently, left bundle branch area pacing (LBBAP) has been shown to be an alternative form of CRT. OBJECTIVES: The purpose of this study was to investigate sex-specific outcomes for death and heart failure events in a large, international, multicenter, cohort of patients undergoing CRT with BVP or LBBAP. METHODS: In this international study of 1,778 patients (575 female and 1203 male), sex-specific survival analysis was performed to compare the effect of LBBAP-CRT relative to BVP-CRT on the combined endpoint of death or heart failure hospitalization (HFH), and secondary endpoints of HFH only, and death alone. RESULTS: Female patients were more likely to have nonischemic cardiomyopathy and left bundle branch block (LBBB) and less likely to have hypertension, diabetes, or coronary artery disease than were male patients. Overall, female patients had a better result with LBBAP compared with BVP than did male patients, with a significant 36% reduction in death or HFH (HR: 0.64; 95% CI: 0.43 to 0.97; P = 0.03) and a significant 60% reduction in HFH alone (HR: 0.4; 95% CI: 0.24 to 0.69, P < 0.01). Women had a greater reduction in death or HFH among those with nonischemic cardiomyopathy (HR: 0.45 95% CI: 0.26 to 0.79; P < 0.01) and LBBB (HR: 0.49; 95% CI: 0.27 to 0.87; P < 0.01). Sex-specific echocardiographic outcomes were better in women than in men. CONCLUSIONS: Women obtained significantly greater reductions in the combined endpoint of death or HFH (primarily driven by reduction in HFH) with LBBAP compared with BVP among patients requiring CRT than did men.

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$a BACKGROUND: Cardiac resynchronization therapy (CRT) using biventricular pacing (BVP) has been associated with greater clinical improvement in women than men. Recently, left bundle branch area pacing (LBBAP) has been shown to be an alternative form of CRT. OBJECTIVES: The purpose of this study was to investigate sex-specific outcomes for death and heart failure events in a large, international, multicenter, cohort of patients undergoing CRT with BVP or LBBAP. METHODS: In this international study of 1,778 patients (575 female and 1203 male), sex-specific survival analysis was performed to compare the effect of LBBAP-CRT relative to BVP-CRT on the combined endpoint of death or heart failure hospitalization (HFH), and secondary endpoints of HFH only, and death alone. RESULTS: Female patients were more likely to have nonischemic cardiomyopathy and left bundle branch block (LBBB) and less likely to have hypertension, diabetes, or coronary artery disease than were male patients. Overall, female patients had a better result with LBBAP compared with BVP than did male patients, with a significant 36% reduction in death or HFH (HR: 0.64; 95% CI: 0.43 to 0.97; P = 0.03) and a significant 60% reduction in HFH alone (HR: 0.4; 95% CI: 0.24 to 0.69, P < 0.01). Women had a greater reduction in death or HFH among those with nonischemic cardiomyopathy (HR: 0.45 95% CI: 0.26 to 0.79; P < 0.01) and LBBB (HR: 0.49; 95% CI: 0.27 to 0.87; P < 0.01). Sex-specific echocardiographic outcomes were better in women than in men. CONCLUSIONS: Women obtained significantly greater reductions in the combined endpoint of death or HFH (primarily driven by reduction in HFH) with LBBAP compared with BVP among patients requiring CRT than did men.
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$a Sharma, Parikshit S $u Rush University Medical Center, Chicago, Illinois, USA
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$a Cano, Óscar $u Hospital Universitari i Politècnic La Fe and Centro de Investigaciones Biomédicas en RED en Enfermedades Cardiovasculares,Valencia, Spain
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$a Ponnusamy, Shunmuga Sundaram $u Velammal Medical College Hospital and Research Institute, Madurai, India
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$a Herweg, Bengt $u University of South Florida Morsani College of Medicine, Tampa, Florida, USA
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$a Zanon, Francesco $u Santa Maria Della Misericordia Hospital, Rovigo, Italy
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$a Jastrzebski, Marek $u First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland
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$a Zou, Jiangang $u Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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$a Chelu, Mihail G $u Baylor College of Medicine and Texas Heart Institute, Houston, Texas, USA
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$a Vernooy, Kevin $u Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
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$a Whinnett, Zachary I $u National Heart and Lung Institute, Imperial College London, London, United Kingdom
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$a Nair, Girish M $u University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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$a Molina-Lerma, Manuel $u Hospital Universitario Virgen de las Nieves, Granada, Spain
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$a Curila, Karol $u Cardiocenter, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
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$a Ellenbogen, Kenneth A $u Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
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$a Vijayaraman, Pugazhendhi $u Geisinger Heart Institute, Wilkes Barre, Pennsylvania, USA. Electronic address: pvijayaraman1@geisinger.edu
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