Male sex increases mortality in ventricular tachyarrhythmias

Abstract

Background Ventricular tachyarrhythmias are still associated with poor clinical outcomes. Therefore, it is important to stratify high‐risk patients presenting with ventricular tachyarrhythmias for their individual risk of future outcomes. Aim To assess the impact of male sex on survival in patients presenting with ventricular tachyarrhythmias. Methods All consecutive patients surviving ventricular tachycardia (VT) and fibrillation (VF) on admission from 2002 to 2016 were included and stratified according to sex differences by propensity score matching. The primary prognostic end‐point was all‐cause mortality at 30 months. Secondary end‐points were all‐cause mortality at 30 days, at index hospitalisation, after discharge, the composite of recurrent ventricular tachyarrhythmias and appropriate implantable cardioverter defibrillator (ICD) therapies, and finally rehospitalisation related to ventricular tachyarrhythmias. Results A total of 784 (392 males and 392 females) matched patients was included. The rate of VT and VF was similar in both groups (VT: male 65% vs female 62%; VF: male 35% vs female 38%). Male sex was independently associated with the primary end‐point of all‐cause mortality at 30 months (31% vs 23%; hazard ratio (HR) = 1.432; 95% confidence interval (CI) 1.089–1.883; P = 0.010) as well as with the secondary end‐point of all‐cause mortality at index hospitalisation (mortality rate 31% vs 23%; log‐rank P = 0.010; HR = 1.432; 95% CI 1.089–1.883; P = 0.010; mortality rate 10% vs 15%; HR = 1.685; 95% CI 1.117–2.542; P = 0.013). No differences in further secondary end‐points were found. Sex differences of the primary end‐point were predominantly observed in patients with VT at index (mortality rate 28% versus 20%; HR = 1.512; 95% CI 1.040–2.189; P = 0.028), without an ICD and with left ventricular ejection fraction ≥35% (log‐rank values, P < 0.05). Conclusion Males presenting with ventricular tachyarrhythmias on admission were associated with higher all‐cause mortality at 30 months and all‐cause mortality at index hospitalisation.

Sex‐related differences in contemporary biomarkers for heart failure: a review

“…67 Several mechanisms have been proposed to explain raised cTns in HF, 131,132 but the exact pathophysiology of sex-related differences remains to be elucidated. We postulate that a greater prevalence of cardiac comorbidities [133][134][135] (e.g. atrial fibrillation, ventricular arrhythmias, coronary artery disease, cardiomyopathies, myocarditis) and male-specific hormonal mechanisms 136 According to data from the study conducted by Ndumele and colleagues (n = 9507), obesity was strongly associated with elevated cTns.…”