背景:双心室起搏(BVP)似乎在女性中具有更明显的优势,然而,传导系统起搏(CSP)的影响仍未得到充分表征.本研究旨在阐明典型左束支传导阻滞(LBBB)患者在接受CSP的临床结局中的性别差异。特别注重评估促成因素。
方法:连续诊断为非缺血性心肌病的患者,左心室射血分数(LVEF)≤40%,并将典型的LBBB表现为Strauss标准,接受CSP。随后的纵向监测评估了LVEF的改善以及死亡率或心力衰竭住院(HFH)的复合终点。
结果:在纳入的176例患者中,女性(n=84,平均年龄:69.5±8.8岁)心脏尺寸较小(LVEDd,62.0±8.3mmvs.64.8±7.9mm,P=0.023)和较短的基线QRSd(163.5±17.7msvs.169.7±15.1ms;P=0.013)比男性高。在完成随访的171名患者中,在120(70%)中观察到超反应,女性发病率高于男性(78.3%vs.62.5%,P=0.024)。女性的死亡或HFH发病率在数字上较低(7.1%vs13%,对数秩P=0.216)。值得注意的是,在相同的心电图和/或超声心动图参数值下,超应答显示女性与男性相比存在显著差异.性别与超反应之间的中介分析表明,LVEDd和pQRSd起着中介作用,调解比例分别为26.07%和27.98%,分别。
结论:女性可能从CSP中获得更多好处,和pQRSd和LVEDd部分驱动这种差异。
BACKGROUND: Biventricular pacing (BVP) appears to confer more pronounced advantages in women, yet the impact of conduction system pacing (CSP) remains insufficiently characterized. This investigation seeks to elucidate sex-specific disparities in clinical outcomes among patients with typical left bundle branch block (LBBB) undergoing CSP, with a particular focus on assessing contributory factors.
METHODS: Consecutive patients diagnosed with nonischemic cardiomyopathy, exhibiting left ventricular ejection fraction (LVEF) ≤ 40%, and manifesting typical LBBB as Strauss criteria, underwent CSP. Subsequent longitudinal monitoring assessed improvements in LVEF and the composite endpoint of mortality or heart failure hospitalization (HFH).
RESULTS: Among the included 176 patients, women (n = 84, mean age: 69.5 ± 8.8 years) displayed smaller heart size (LVEDd, 62.0 ± 8.3 mm vs. 64.8 ± 7.9 mm, P = 0.023) and shorter baseline QRSd (163.5 ± 17.7 ms vs. 169.7 ± 15.1 ms; P = 0.013) than men. Of the 171 patients who completed the follow-up, super-response was observed in 120 (70%), with a higher occurrence in women than men (78.3% vs. 62.5%, P = 0.024). The incidence of death or HFH was numerically lower in women (7.1% Vs 13%, Log-rank P = 0.216). Notably, the super-response showed a significant difference in women compared to men at the same electrocardiography and/or echocardiographic parameters value. Mediation analysis between sex and super-response revealed that LVEDd and pQRSd play an intermediary role, with the mediation proportion of 26.07% and 27.98%, respectively.
CONCLUSIONS: Women may derive more benefits from CSP, and pQRSd and LVEDd partly drive this difference.