The Impact Of Gender Difference On Clinical And Echocardiographic Outcomes In Patients With Heart Failure After Cardiac Resynchronization Therapy:A Meta-analysis

Background Cardiac resynchronization therapy(CRT)has significantly reduced the mortality of the patients with HF,improving cardiac capacity and quality of life,optimizing cardiac synchronous contraction and reversing left ventricular remodeling.However,the impact of gender differences on the outcome for the patients with heart failure treated with CRT remains controversial.Objective To clarify the effect of gender difference on the clinical and echocardiographic outcomes in patients with heart failure after CRT.Methods Pubmed,Embase,and the Cochrane library as well as Chinese databases including CNKI,Wanfang,CBM,and VIP were searched from establishment to November-30-2017.All the preliminary literatures were screened according to the predefined inclusion and exclusion criteria,quality assessment was also performed.A detailed table including items of baseline characteristics and outcomes were also made before data extraction.The outcomes of this study including clinical(all-cause mortality,NYHA functional class,six-minute walk distance and quality of life)and echocardiographic(left ventricular ejection fraction,left ventricular end-diastolic diameter,left ventricular end-diastolic volume and left ventricular end-systolic volume).Stata software was recruited into this meta-analysis.Results Eleven studies with 149,259 were identified.This study demonstrated that female patients have significantly lower all-cause mortality compared with male patients(OR 0.50,95%CI 0.36~0.70 I~2=67.4%).No significant difference was observed in the increment of New York Heart Association(NYHA)functional class(standard mean difference[SMD]-0.07,95%CI-0.15~0.01,I~2=46%)),6-minitue walk distance(6-MWD)(SMD-0.05,95%CI-0.07~0.17,I~2=0%),and quality of life(Qo L)(SMD-0.10,95%CI-0.23~0.03,I~2=0%).Female patients showed statistically significant increment of left ventricular ejection fraction(LVEF)(SMD 0.25,95%CI0.07~0.43,I~2=64%)and decrement of left ventricular end diastolic diameter(LVEDD)(SMD-0.22,95%CI-0.36~-0.09,I~2=2.3%)than those of male patients.No statistically significant difference was noticed in left ventricular end diastolic volume(LVEDV)(SMD-0.08,95%CI-0.25~0.08,I~2=0%)and left ventricular end systolic volume(LVESV)(SMD-0.16,95%CI-0.40~0.09,I~2=67.2%)between both genders.Conclusion This study suggests that female patients underwent CRT can benefit more than males.However,further long-term follow-up is required.