Abstract
Sex differences in nonischemic cardiomyopathy patients presenting for device implantation – the marven study
Journal of cardiovascular magnetic resonance, Vol.27(Suppl 1), 101540
Spring 2025
DOI: 10.1016/j.jocmr.2024.101540
Abstract
Background: Risk stratification in nonischemic cardiomyopathy (NICM) remains a challenge. Current guidelines for device implantation are based on left ventricular ejection fraction (LVEF) and QRS duration. The aim of the MARVEN study (Clinical, Electrocardiographic, and Cardiac Magnetic Resonance Imaging Risk Factors Associated with Ventricular Tachyarrhythmias in Nonischemic Cardiomyopathy) was to evaluate clinical and imaging models for predicting ventricular arrhythmias in patients undergoing cardiac resynchronization therapy defibrillator (CRT-D) or implantable cardioverter defibrillator (ICD) implantation. The purpose of the current analysis was to evaluate sex differences in NICM patients presenting for device implant.
Methods: NICM patients scheduled for CRT-D or ICD implantation were recruited across 27 participating US sites and underwent Holter monitoring and CMR exams with cine and late gadolinium enhancement (LGE) imaging prior to device implant. All image analysis was performed at the CMR Core Lab with validated software (cvi42, Circle Cardiovascular Imaging, Calgary). LGE presence, location, and extent (by AHA segments) were evaluated. LGE was deemed to be present if identified in two contiguous slices or two orthogonal planes; isolated right ventricular insertion site fibrosis was excluded. The primary endpoint consisted of ventricular tachycardia/fibrillation (VT/VF) >188 bpm on device check; secondary endpoint included VT/VF >188 bpm or death.
Results: A total of 303 patients (mean age 60±13 years, 52% female) were included in the final analysis. CRT-Ds were implanted in 225 patients (74%); whereas ICDs in 72 patients (24%). The mean LVEF was 24±6%, with 42% of patients having NYHA class III. Males had larger indexed LV and right ventricular (RV) volumes and LV mass as compared to females (Table 1). RV function was significant worse in males. The overall prevalence of LGE was high in this cohort (78%), with males exhibiting higher LGE burden vs females (p< 0.001). There were no significant differences in age, history of heart failure hospitalization, LVEF, NYHA class, or type of device implanted between sexes. Overall rates of guideline-directed medical therapies (GDMT) were high and similar between sexes. During a mean follow up of 30±16 months, males had a higher incidence of VT/VF >188 bpm than females (10% vs 3%, p=0.02) (Figure 1). In this cohort of frequent GDMT and CRT-D use rates of death were low and similar between sexes.
Conclusion: In a contemporary cohort of NICM patients, treated with guideline directed medical therapy and undergoing device implantation, sex differences remain in CMR characteristics and outcomes. Males have more ventricular remodeling despite similar EF, worse RV function, higher prevalence of LGE, and higher incidence of ventricular arrhythmias. Future studies are needed to determine the need for sex-based approaches in risk stratification of NICM patients.
Details
- Title: Subtitle
- Sex differences in nonischemic cardiomyopathy patients presenting for device implantation – the marven study
- Creators
- Karolina M. Zareba - The Ohio State UniversitySuzanne Smart - The Ohio State UniversityMatthew A. Bernabei - University of Pennsylvania Health SystemChetan Shenoy - University of Minnesota Medical SchoolMadhu Reddy - The University of Kansas Health SystemSamuel Johnston - University of IowaSrinivas Rajsheker - University of CincinnatiMuhammad Afzal - The Ohio State UniversityMayer Rashtian - Huntington HospitalPeter Santucci - Loyola University Medical CenterDavid Huang - University of Rochester Medical CenterStephen Winters - Morristown Medical CenterKristina Cutter - University of Rochester Medical CenterScott McNitt - University of Rochester Medical CenterBronislava Polonsky - University of Rochester Medical CenterWojciech Zareba - University of Rochester Medical Center
- Resource Type
- Abstract
- Publication Details
- Journal of cardiovascular magnetic resonance, Vol.27(Suppl 1), 101540
- DOI
- 10.1016/j.jocmr.2024.101540
- ISSN
- 1097-6647
- Publisher
- Elsevier Inc
- Language
- English
- Date published season
- Spring 2025
- Date published
- 2025
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984786441402771
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