Abstract 16637: Left Ventricular Mass Predicts Response to Cardiac Resynchronization Therapy in Men but Not Women

• Published in: Circulation (New York, N.Y.) Vol. 138; no. Suppl_1 Suppl 1; p. A16637
• Main Authors: Ward, Chad C, Ayinde, Hakeem, Adams, Casey, Adeola, Oluwaseun, Zubairu, Josiah, Dezorzi, Christopher, Hopson, James, Sigurdsson, Gardar, Giudici, Michael
• Format: Journal Article
• Language: English
• Published: by the American College of Cardiology Foundation and the American Heart Association, Inc 06.11.2018
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.138.suppl_1.16637

IntroductionThe effect of left ventricular mass (LVM) on response to cardiac resynchronization therapy (CRT) is not well known.HypothesisWe hypothesize that baseline LVM would be positively associated with improved CRT outcomes.MethodsWe retrospectively studied 343 consecutive patients who received CRT at our institution between 2008 and 2014. LVM was measured by echocardiography using the truncated ellipsoid method. Primary outcome was all-cause mortality. Secondary outcomes were (1) change in left ventricular ejection fraction (LVEF) by > 5% at 6-12 months and (2) change in QRSd within 3 months.ResultsThere were 241 males and 102 females. Mean age at CRT implant was 63.6 ± 11.9 years. LVM was 366 ± 367g. Ischemic cardiomyopathy and left bundle branch block (LBBB) were present in 57% and 67% respectively. Fifty three percent of the study cohort had NYHA class III or IV at the time of implant. Death occurred in 36% of patients at a median follow up of 2.2 years. LVEF improved by > 5% in 65% of patients at 6-12 months while QRSd decreased by a mean of 6.7 ± 27.8 ms within 3 months. The relationship between LVM and CRT response appeared to be strongly sex-specific. Higher LVM was associated with reduced mortality in men when LVM was used as a continuous and categorical variable dichotomized at the 75th percentile ([OR 0.999 (0.998-1.0000; p=0.068)] and [OR 0.47 (0.23-1.00; p=0.05)] respectively). There was no association in women (p=0.826). Higher LVM predicted improvement in LVEF in men [OR 0.99898 (0.9983-0.9997; p=0.005)] but not in women (p=0.324). Men with higher LVM experienced greater reduction in QRSd [OR 1.0015 (1.0006-1.0024; p=0.001)]. Again, there was no association in women (p=0.322). The relationship between LVM and change in both LVEF and QRSd remained significant and sex-specific after adjusting for age, LBBB, ischemic cardiomyopathy and atrial fibrillation (OR 0.99904, p=0.039 and OR 1.001, p=0.028 respectively in men).ConclusionsLeft ventricular mass is an independent predictor of CRT outcomes in men but not in women. In males, greater left ventricular mass predicted improvement in LVEF as well as reduction in QRSd. This remained significant after adjusting for age, LBBB, ischemic cardiomyopathy, and atrial fibrillation.