Sex-specific mortality risk by QRS morphology and duration in patients receiving CRT: Results from the NCDR

Robbert Zusterzeel, Jeptha P. Curtis, Daniel A. Caños, William E. Sanders, Kimberly A. Selzman, Ileana L. Pina, Erica S. Spatz, Haikun Bao, Angelo Ponirakis, Paul D. Varosy, Frederick A. Masoudi, David G. Strauss

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

Background Prior studies have suggested that women have better outcomes than men after cardiac resynchronization therapy-defibrillator (CRT-D) implantation. Objectives The purpose of this study was to compare mortality after CRT-D implantation by sex, QRS morphology, and duration. Methods Survival curves and covariate adjusted hazard ratios (HR) were used to assess mortality by sex in 31,892 CRT-D patients in the National Cardiovascular Data Registry (NCDR), implantable cardioverter defibrillator (ICD) registry between 2006 and 2009, with up to 5 years' follow-up (median 2.9 years, interquartile range: 2.0 to 3.9 years). Patients were grouped by QRS morphology and 10-ms increments in QRS duration. Results Among patients with left bundle branch block (LBBB), women had a 21% lower mortality risk than men (HR: 0.79; 95% CI: 0.74 to 0.84; p < 0.001); however, there was no sex difference in non-LBBB (HR: 0.95; 95% CI: 0.85 to 1.06; p = 0.37). Longer QRS duration was associated with better survival in both sexes with LBBB, but not in patients without LBBB. Compared with women with LBBB and QRS of 120 to 129 ms, women with LBBB and QRS of 140 to 149 ms had a 27% lower mortality (HR: 0.73; 95% CI: 0.60 to 0.88; p = 0.001); this difference was 18% in men (HR: 0.82; 95% CI: 0.71 to 0.93; p = 0.003). Mortality in LBBB and QRS of 150 ms or longer compared with those with LBBB and QRS of 120 to 129 ms was similar between sexes (HR: 0.61 to 0.68; p < 0.001 for women and HR: 0.58 to 0.66; p < 0.001 for men). Sex interactions within 10-ms groups were not significant. Conclusions Among patients with LBBB who received CRT-D, mortality is lower in women than men. Additionally, longer QRS duration in LBBB is associated with better survival in both sexes. In contrast, there is no sex difference in patients without LBBB, regardless of QRS duration. Further studies should include a non-CRT comparator group to confirm these findings.

Original languageEnglish (US)
Pages (from-to)887-894
Number of pages8
JournalJournal of the American College of Cardiology
Volume64
Issue number9
DOIs
StatePublished - Sep 2 2014
Externally publishedYes

Fingerprint

Bundle-Branch Block
Registries
Mortality
Cardiac Resynchronization Therapy
Defibrillators
Sex Characteristics
Survival
Implantable Defibrillators
Sex Ratio

Keywords

  • cardiac resynchronization therapy
  • men
  • QRS duration
  • QRS morphology
  • women

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Zusterzeel, R., Curtis, J. P., Caños, D. A., Sanders, W. E., Selzman, K. A., Pina, I. L., ... Strauss, D. G. (2014). Sex-specific mortality risk by QRS morphology and duration in patients receiving CRT: Results from the NCDR. Journal of the American College of Cardiology, 64(9), 887-894. https://doi.org/10.1016/j.jacc.2014.06.1162

Sex-specific mortality risk by QRS morphology and duration in patients receiving CRT : Results from the NCDR. / Zusterzeel, Robbert; Curtis, Jeptha P.; Caños, Daniel A.; Sanders, William E.; Selzman, Kimberly A.; Pina, Ileana L.; Spatz, Erica S.; Bao, Haikun; Ponirakis, Angelo; Varosy, Paul D.; Masoudi, Frederick A.; Strauss, David G.

In: Journal of the American College of Cardiology, Vol. 64, No. 9, 02.09.2014, p. 887-894.

Research output: Contribution to journalArticle

Zusterzeel, R, Curtis, JP, Caños, DA, Sanders, WE, Selzman, KA, Pina, IL, Spatz, ES, Bao, H, Ponirakis, A, Varosy, PD, Masoudi, FA & Strauss, DG 2014, 'Sex-specific mortality risk by QRS morphology and duration in patients receiving CRT: Results from the NCDR', Journal of the American College of Cardiology, vol. 64, no. 9, pp. 887-894. https://doi.org/10.1016/j.jacc.2014.06.1162
Zusterzeel, Robbert ; Curtis, Jeptha P. ; Caños, Daniel A. ; Sanders, William E. ; Selzman, Kimberly A. ; Pina, Ileana L. ; Spatz, Erica S. ; Bao, Haikun ; Ponirakis, Angelo ; Varosy, Paul D. ; Masoudi, Frederick A. ; Strauss, David G. / Sex-specific mortality risk by QRS morphology and duration in patients receiving CRT : Results from the NCDR. In: Journal of the American College of Cardiology. 2014 ; Vol. 64, No. 9. pp. 887-894.
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title = "Sex-specific mortality risk by QRS morphology and duration in patients receiving CRT: Results from the NCDR",
abstract = "Background Prior studies have suggested that women have better outcomes than men after cardiac resynchronization therapy-defibrillator (CRT-D) implantation. Objectives The purpose of this study was to compare mortality after CRT-D implantation by sex, QRS morphology, and duration. Methods Survival curves and covariate adjusted hazard ratios (HR) were used to assess mortality by sex in 31,892 CRT-D patients in the National Cardiovascular Data Registry (NCDR), implantable cardioverter defibrillator (ICD) registry between 2006 and 2009, with up to 5 years' follow-up (median 2.9 years, interquartile range: 2.0 to 3.9 years). Patients were grouped by QRS morphology and 10-ms increments in QRS duration. Results Among patients with left bundle branch block (LBBB), women had a 21{\%} lower mortality risk than men (HR: 0.79; 95{\%} CI: 0.74 to 0.84; p < 0.001); however, there was no sex difference in non-LBBB (HR: 0.95; 95{\%} CI: 0.85 to 1.06; p = 0.37). Longer QRS duration was associated with better survival in both sexes with LBBB, but not in patients without LBBB. Compared with women with LBBB and QRS of 120 to 129 ms, women with LBBB and QRS of 140 to 149 ms had a 27{\%} lower mortality (HR: 0.73; 95{\%} CI: 0.60 to 0.88; p = 0.001); this difference was 18{\%} in men (HR: 0.82; 95{\%} CI: 0.71 to 0.93; p = 0.003). Mortality in LBBB and QRS of 150 ms or longer compared with those with LBBB and QRS of 120 to 129 ms was similar between sexes (HR: 0.61 to 0.68; p < 0.001 for women and HR: 0.58 to 0.66; p < 0.001 for men). Sex interactions within 10-ms groups were not significant. Conclusions Among patients with LBBB who received CRT-D, mortality is lower in women than men. Additionally, longer QRS duration in LBBB is associated with better survival in both sexes. In contrast, there is no sex difference in patients without LBBB, regardless of QRS duration. Further studies should include a non-CRT comparator group to confirm these findings.",
keywords = "cardiac resynchronization therapy, men, QRS duration, QRS morphology, women",
author = "Robbert Zusterzeel and Curtis, {Jeptha P.} and Ca{\~n}os, {Daniel A.} and Sanders, {William E.} and Selzman, {Kimberly A.} and Pina, {Ileana L.} and Spatz, {Erica S.} and Haikun Bao and Angelo Ponirakis and Varosy, {Paul D.} and Masoudi, {Frederick A.} and Strauss, {David G.}",
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TY - JOUR

T1 - Sex-specific mortality risk by QRS morphology and duration in patients receiving CRT

T2 - Results from the NCDR

AU - Zusterzeel, Robbert

AU - Curtis, Jeptha P.

AU - Caños, Daniel A.

AU - Sanders, William E.

AU - Selzman, Kimberly A.

AU - Pina, Ileana L.

AU - Spatz, Erica S.

AU - Bao, Haikun

AU - Ponirakis, Angelo

AU - Varosy, Paul D.

AU - Masoudi, Frederick A.

AU - Strauss, David G.

PY - 2014/9/2

Y1 - 2014/9/2

N2 - Background Prior studies have suggested that women have better outcomes than men after cardiac resynchronization therapy-defibrillator (CRT-D) implantation. Objectives The purpose of this study was to compare mortality after CRT-D implantation by sex, QRS morphology, and duration. Methods Survival curves and covariate adjusted hazard ratios (HR) were used to assess mortality by sex in 31,892 CRT-D patients in the National Cardiovascular Data Registry (NCDR), implantable cardioverter defibrillator (ICD) registry between 2006 and 2009, with up to 5 years' follow-up (median 2.9 years, interquartile range: 2.0 to 3.9 years). Patients were grouped by QRS morphology and 10-ms increments in QRS duration. Results Among patients with left bundle branch block (LBBB), women had a 21% lower mortality risk than men (HR: 0.79; 95% CI: 0.74 to 0.84; p < 0.001); however, there was no sex difference in non-LBBB (HR: 0.95; 95% CI: 0.85 to 1.06; p = 0.37). Longer QRS duration was associated with better survival in both sexes with LBBB, but not in patients without LBBB. Compared with women with LBBB and QRS of 120 to 129 ms, women with LBBB and QRS of 140 to 149 ms had a 27% lower mortality (HR: 0.73; 95% CI: 0.60 to 0.88; p = 0.001); this difference was 18% in men (HR: 0.82; 95% CI: 0.71 to 0.93; p = 0.003). Mortality in LBBB and QRS of 150 ms or longer compared with those with LBBB and QRS of 120 to 129 ms was similar between sexes (HR: 0.61 to 0.68; p < 0.001 for women and HR: 0.58 to 0.66; p < 0.001 for men). Sex interactions within 10-ms groups were not significant. Conclusions Among patients with LBBB who received CRT-D, mortality is lower in women than men. Additionally, longer QRS duration in LBBB is associated with better survival in both sexes. In contrast, there is no sex difference in patients without LBBB, regardless of QRS duration. Further studies should include a non-CRT comparator group to confirm these findings.

AB - Background Prior studies have suggested that women have better outcomes than men after cardiac resynchronization therapy-defibrillator (CRT-D) implantation. Objectives The purpose of this study was to compare mortality after CRT-D implantation by sex, QRS morphology, and duration. Methods Survival curves and covariate adjusted hazard ratios (HR) were used to assess mortality by sex in 31,892 CRT-D patients in the National Cardiovascular Data Registry (NCDR), implantable cardioverter defibrillator (ICD) registry between 2006 and 2009, with up to 5 years' follow-up (median 2.9 years, interquartile range: 2.0 to 3.9 years). Patients were grouped by QRS morphology and 10-ms increments in QRS duration. Results Among patients with left bundle branch block (LBBB), women had a 21% lower mortality risk than men (HR: 0.79; 95% CI: 0.74 to 0.84; p < 0.001); however, there was no sex difference in non-LBBB (HR: 0.95; 95% CI: 0.85 to 1.06; p = 0.37). Longer QRS duration was associated with better survival in both sexes with LBBB, but not in patients without LBBB. Compared with women with LBBB and QRS of 120 to 129 ms, women with LBBB and QRS of 140 to 149 ms had a 27% lower mortality (HR: 0.73; 95% CI: 0.60 to 0.88; p = 0.001); this difference was 18% in men (HR: 0.82; 95% CI: 0.71 to 0.93; p = 0.003). Mortality in LBBB and QRS of 150 ms or longer compared with those with LBBB and QRS of 120 to 129 ms was similar between sexes (HR: 0.61 to 0.68; p < 0.001 for women and HR: 0.58 to 0.66; p < 0.001 for men). Sex interactions within 10-ms groups were not significant. Conclusions Among patients with LBBB who received CRT-D, mortality is lower in women than men. Additionally, longer QRS duration in LBBB is associated with better survival in both sexes. In contrast, there is no sex difference in patients without LBBB, regardless of QRS duration. Further studies should include a non-CRT comparator group to confirm these findings.

KW - cardiac resynchronization therapy

KW - men

KW - QRS duration

KW - QRS morphology

KW - women

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