Sex differences in response to cardiac resynchronization therapy: areal-world cohort analysis

Introduction

Cardiac resynchronizaon therapy (CRT) improves symptoms, ventricular function, and prognosis in patients with heart failure and electrical dyssynchrony. Previous studies have suggested a better response among women, but evidence in real-world populations remains limited.

Objective

To evaluate sex differences in clinical, echocardiographic, and global response to CRT in a consecutive cohort from a tertiary center.

Methods

Retrospective cohort of patients undergoing CRT (N=160).Three response endpoints were defined: Clinical response- improvement of ≥1 NYHA class and no heart-failure hospitalization; Echocardiographic response—absolute ΔLVEF ≥10% at follow-

up; Global response—simultaneous fulfillment of the clinical and echocardiographic criteria.

Responses were compared between sexes using chi-square/Fisher’s exact test. Independent predictors of global response were identified through mulvariable logistic regression (complete-case N=73), including sex, age, baseline LVEF, BMI, valvular disease, and coronary disease. The mean follow-up was 8 years.

Results

A total of 160 patients underwent CRT (67% men). Baseline clinical characteriscs were broadly similar between sexes, except for a lower prevalence of coronary artery disease (p<0.05). Baseline LVEF, NYHA class, and comorbidity profiles were comparable. In univariable analyses, women demonstrated significantly higher rates of clinical, echocardiographic, and global CRT response (all p<0.05).

In the mulvariable logisc regression (complete-case N=73), female sex remained an independent predictor of global response (OR 6.41; 95% CI 1.46–28.3; p=0.014). Higher baseline LVEF was also associated with greater odds of response (OR 1.11 per 1% increase; 95% CI 1.02–1.21; p=0.012). Conversely, coronary artery disease was associated with reduced response (OR 0.21; 95% CI 0.06–0.77;

p=0.019). Age, BMI, and valvular disease were not significant predictors.

Conclusion

In this real-world CRT cohort, after mulvariable adjustment, women demonstrated a substantially higher likelihood of global CRT response, and higher baseline LVEF further increased the probability of response, while coronary artery disease predicted poorer outcomes. These findings highlight the importance of incorporating sex and baseline LVEF into patient selection and counseling

for CRT in real-world practice.