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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
De
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HF
Ho
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lizati
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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
