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Cardiac Resynchronization Therapy:

Gender Related Differences in Left Ventricular Reverse Remodeling


Address for reprints: Alessio Lilli, M.D., Department Heart and Vessels, University of Florence, Viale Morgagni, 85, 50134 Florence, Italy. Fax: 00390554360976; e-mail:


Aim:Gender related differences in epidemiology, treatment, and prognosis of heart failure (HF) have been reported. We examined the sex influence in patients treated with cardiac resynchronization therapy (CRT).

Methods and Results:Out of 334 consecutive HF patients (19.7% women) who underwent CRT, 195 patients reached clinical and echocardiographic evaluation at six and 12 months and were selected for analysis. A reduction in left ventricular (LV) end-diastolic volume/m2 (EDVi) and end systolic volume/m2 (ESVi) was evident in the overall population at six months (P < 0.001) and from six to 12 months (P < 0.001). Compared to men, women showed significantly greater changes in LV volumes at mid (P < 0.05) and long-term (P < 0.001) follow-up and a significantly higher LV ejection fraction (EF) (40.8 ± 12.3 vs 34.1 ± 10.1, P < 0.01) at one year. Multiple regression analysis, including several demographic and clinical parameters, revealed that female gender is independently associated with greater reduction in LV ESVi.

At the 12-month follow-up, the proportion of responders (defined in terms of ESV reduction by at least 10%) was higher in women than in men (76.1% vs 59.3%, P < 0.05).

Conclusions:CRT induced a gender specific LV remodeling response.