Author + information
- Received March 9, 2010
- Revision received June 1, 2010
- Accepted June 15, 2010
- Published online February 15, 2011.
- Aysha Arshad, MD⁎,
- Arthur J. Moss, MD†,⁎ (, )
- Elyse Foster, MD‡,
- Luigi Padeletti, MD§,
- Alon Barsheshet, MD†,
- Ilan Goldenberg, MD†,
- Henry Greenberg, MD⁎,
- W. Jackson Hall, PhD†,
- Scott McNitt, MS†,
- Wojciech Zareba, MD, PhD†,
- Scott Solomon, MD∥,
- Jonathan S. Steinberg, MD⁎,
- MADIT-CRT Executive Committee
- ↵⁎Reprint requests and correspondence:
Dr. Arthur J. Moss, Heart Research Follow-up Program, Box 653, University of Rochester Medical Center, Rochester, New York 14642
Objectives The purpose of this study was to investigate the factors related to sex-specific outcomes for death and heart failure events in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy) trial.
Background In the MADIT-CRT trial, women seemed to achieve a better result from resynchronization therapy than men.
Methods All 1,820 patients (453 female and 1,367 male) enrolled in the MADIT-CRT trial were included in this sex-specific outcome analysis that compared the effect of cardiac resynchronization therapy with defibrillator (CRT-D) relative to implanted cardioverter-defibrillator (ICD) on death or heart failure (whichever came first), heart failure only, and death at any time.
Results Female patients were more likely to have nonischemic cardiomyopathy and left bundle branch block and less likely to have renal dysfunction than male patients. Overall, female patients had a better result from CRT-D therapy than male patients, with a significant 69% reduction in death or heart failure (hazard ratio: 0.31, p < 0.001) and 70% reduction in heart failure alone (hazard ratio: 0.30, p < 0.001). Women had a significant 72% reduction in all-cause mortality in the total population (hazard ratio: 0.28, p = 0.02) and significant 82% and 78% reductions in mortality in those with QRS ≥150 ms and with left bundle branch block conduction disturbance, respectively, with sex-by-treatment interactions for mortality reduction significant at p < 0.05 in each of these 3 patient groups. These beneficial CRT-D effects among women were associated with consistently greater echocardiographic evidence of reverse cardiac remodeling in women than in men.
Conclusions Women in the MADIT-CRT trial obtained significantly greater reductions in death or heart failure (whichever came first), heart failure alone, and all-cause mortality with CRT-D therapy than men, with consistently greater echocardiographic evidence of reverse cardiac remodeling in women than in men. (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy [MADIT-CRT]; NCT00180271).
Dr. Arshad is a consultant for Spectranetics and LifeWatch, and is on the Speakers' Bureau for Medtronic, Boston Scientific, and St. Jude. Drs. Moss, Goldenberg, and Zareba have received research grant support from Boston Scientific of >$10,000. Dr. Foster has received research support from Boston Scientific and EBR Systems of >$10,000. Dr. Padeletti has received research sponsorship from Boston Scientific, St. Jude Medical, Medtronic, and Sorin. Dr. Solomon has received research support and consulting fees from Boston Scientific of >$10,000. All other authors have reported that they have no relationships to disclose.
Continuing Medical Education (CME) is available for this article.
- Received March 9, 2010.
- Revision received June 1, 2010.
- Accepted June 15, 2010.
- American College of Cardiology Foundation