Cardiac Reverse Remodeling in Mechanically Unloaded Hearts: Analysis of Gender-Specific Differences

 

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Objectives: The abnormal structure and function of cardiomyopathic hearts can be partially reversed in patients supported by a left ventricular assist device (LVAD) by cardiac remodeling. There are growing numbers of reports identifying sex-related differences in the development and prognosis of heart failure. We analyzed gender differences in cardiac reverse remodeling in mechanically unloaded hearts of patients with LVADs.

Methods: A total of 166 patients with end-stage heart failure underwent LVAD implantation with a HeartWare device in our institution between January 2004 and August 2019; 13.3% (n = 22) were female (mean follow-up: 18.95 ± 12.36 months). In 10 female and 63 male patients, functional 1-year follow-up data were obtained and retrospectively analyzed focusing on reverse remodeling.

Results: Mean age at implantation was 57.0 ± 15.2 years for female (F) and 55.0 ± 11.9 years for male (M) patients (p = 0.087). HF etiology was DCM in 36.4% versus 46.5% (n = 8 vs. n = 67), ICM in 54.5 versus 45.1% (n = 12 vs. n = 65), toxic cardiomyopathy in 4.5 versus 1.4% (n = 1 vs. n = 2), and transplant failure in 4.5 vs. 1.4% (n = 1 vs. n = 2); without significant gender differences, myocarditis (3.5%, n = 5) was seen only in male patients. Mean Intermacs profile was 2.7 ± 1.1 in F versus 2.9 ± 1.2 in M (p = 0.78). Thirty-day and long-term mortality showed no significant differences in gender distribution (p = 0.765; p = 0.980), and there was no significant difference in Intermacs adverse events (p = 0.0719). 9.1% F versus 3.0% M underwent LVAD explantation (p = 0.191), 13.6% F versus 9.6% M patients underwent heart transplantation (p = 0.471) during follow-up.

Functional data in the 1-year follow-up group showed proBNP improved 78.12% in F versus 59.93% in M (p = 0.567). Six-min walk test improved by 8.3% in F versus 18.8% in M patients (p = 0.287). LVEDD improved by 4.6 versus 3.4% (p = 0.850), respectively. TAPSE decreased by 12.79% in F and increased by 18.43% in M (p < 0.01). Basal, mid, and apical RVEDD improved by 18.8% (F) vs. 24.6% (M) (p = 0.026).

Conclusion: In our study group, we saw no gender differences regarding baseline characteristics. Mortality and Intermacs adverse events were comparable between sexes. Functional remodeling showed a tendency toward better recovery in male patients with significantly improved recovery of right heart function. Underlying mechanisms of differential right heart remodeling between sexes need to be studied in more detail.