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Example of Sex Differences in CVD

of Clinical Importance - CRT

Viviany R. Taqueti, MD, MPH, FACC Associate Physician, Noninvasive Cardiovascular Imaging Program

Brigham and Women’s Hospital, Boston, MA Assistant Professor, Harvard Medical School

Controversies & Advances in the Treatment of CVD

Beverly Hills, CA

November 17, 2017

HARVARD MEDICAL SCHOOL TEACHING AFFILIATE Heart & Vascular Center

Disclosures

None

Growing Scrutiny for Evidence-Based Use of

Cardiac Procedures and Devices

Understanding of Sex Differences Requires

Sound Scientific Methodology

We will not find them if we do not look..

Shaw LJ and Bairey Merz CN (2017) JACC 70:373–88

An Example of Emerging Clinical Importance:

Cardiac Resynchronization Therapy (CRT)

Biventricular pacing

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An Example of Emerging Clinical Importance:

Cardiac Resynchronization Therapy (CRT)

Mortality (+/- ICD)

Morbidity In patients with heart failure and

LVEF <35% with QRS >120 ms

Abraham WT et al (2002) NEJM; 346:1845-53 Bristow MR et al (2004) NEJM; 350:2140-50 Cleland JG et al (2006) Eur Heart J;27:1928–1932

An Example of Emerging Clinical Importance:

Cardiac Resynchronization Therapy (CRT)

Mortality

Morbidity

LV Volume

LV EF

Hsu JC et al (2012) JACC; 59:2366-73 Richardson M et al (2007) EHJ; 1827 Rickard J et al (2010) Hrt Rhthm; 885

Challenge: Women Under-Represented in Trials

Abraham WT et al (2002) NEJM; Bristow MR et al (2004) NEJM; Hsu JC et al (2012) JACC

Mounting Evidence for Sex-Differences In CRT

Cross-sectional data from the National Inpatient Sample database of

311,009 pts undergoing CRT implantation in the US from 2006-2012

Stratify patients by baseline predictors of those:

(1) Most likely to demonstrate/benefit from CRT response

(2) Less likely to demonstrate reduced ICD efficacy

Chatterjee NA et al (2017) EHJ; 38:1485-1494 Taqueti VR and Bairey Merz CN (2017) EHJ; 38:1495-7

Trends in Sex Differences in CRT-D Use

Chatterjee NA et al (2017) EHJ; 38:1485-1494; Taqueti VR and Bairey Merz CN (2017) EHJ; 38:1495-7

“Precision Medicine” Starts with Sex

Critical Components to Achieving Equity in

Quality of Care for Women (and Men)

Shaw LJ and Bairey Merz CN (2017) JACC 70:373–88

Changing Practice: More Data + Guidelines

Acknowledgements

vtaqueti@bwh.harvard.edu