Cardiac resynchronization therapy outcomes by sex and QRS duration: insights from AdaptResponse and a Real-world registry.

Authors

Theofanie Mela, Wilfried Mullens, Christophe Leclercq, Michael R Gold, Ahmad S Hersi, David Birnie, Kengo Kusano, Gabriela Kaliská, Archana Rao, Kyoko Soejima, Bart Gerritse, Randy F Crossland, Gerasimos Filippatos, Carina Blomström-Lundqvist

Published in

Journal of cardiac failure. Oct 11, 2026. Epub Oct 11, 2026.

Abstract

Sex-related differences in cardiac resynchronization therapy (CRT) outcomes in heart failure (HF) patients, particularly at shorter QRS durations, remain incompletely defined. We evaluated outcomes by sex and QRS duration in AdaptResponse trial and, pooled with Medtronic product surveillance registry (PSR) data, evaluated mortality comparing CRT and no CRT.
AdaptResponse patients (symptomatic HF, LVEF≤35%, Strauss-LBBB, and normal atrioventricular conduction; 43% women) were analyzed by sex and baseline QRS (150ms cut-off), and pooled with PSR CRT and No CRT groups meeting CRT indications. Average treatment effect on treated (ATT) propensity weighting was used to standardize the PSR groups to AdaptResponse baseline characteristics. All-cause mortality was compared between the pooled CRT patients and No CRT controls with weighted Cox models. In AdaptResponse, adjusted mortality rates did not differ significantly between women and men (HR 0.91, 95% CI: 0.72-1.15; p=0.45), and no interaction was observed between sex and QRS (p=0.31). Adjusted mortality in women with QRS<150ms was not statistically different from men with QRS≥150ms (HR 1.02, CI: 0.75-1.38). After ATT-weighting and adjustment, CRT was observed to be associated with lower mortality versus No CRT across sex and QRS subgroups (QRS 120-149ms: HR 0.50, CI: 0.31-0.82 for women and HR 0.51, CI: 0.31-0.86 for men; QRS≥150ms: HR 0.46, CI: 0.28-0.74 for women and HR 0.46, CI: 0.29-0.72 for men; all p<0.05).
In this exploratory analysis, among patients with QRS 120-149ms, CRT was associated with a 49% and 50% relative mortality reduction in men and women, respectively, through five years of follow-up compared to No CRT controls. In AdaptResponse, mortality in women with these shorter QRS durations was similar to men with QRS≥150ms. These observational findings are hypothesis-generating and suggest a potential benefit of CRT in this patient population, particularly for women, but have not been confirmed in a randomized trial.

PMID:
42860180
Bibliographic data and abstract were imported from PubMed on 12 Oct 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.