Long-Term Survival After Implantable Cardiac Defibrillator Therapy According to Sex: A Propensity Matched Study.

Background: Whether the sex factor influences the benefit of the implantable cardioverter-defibrillator (ICD) for the prevention of sudden death remains a subject of debate. Using a prospective registry, we sought to analyze the survival and time to first ICD therapy according to sex. Materials and Methods: Retrospective analysis of a prospective cohort of patients undergoing an ICD implant from 2008 to 2019. Data about time to first appropriate therapy, type of therapy administered, and incidence and causes of mortality were collected. Results: Among 756 ICD patients, 150 (19.8%) were women. Women were younger (51 ± 15 years vs. 61 ± 14 years; p < 0.001) and showed a lower rate of ischemic cardiomyopathy (23% vs. 54%; p < 0.001) and atrial fibrillation (12% vs. 19%; p = 0.05). Women had higher left ventricular ejection fraction (39% ± 17% vs. 35% ± 13%) and showed more frequently left bundle branch block (39% vs. 28%, p = 0.027). The rate of primary prevention (68% vs. 59.6%; p = 0.058) and cardiac resynchronization therapy (27% vs. 19%, p = 0.02) were higher in women. After a median follow-up of 46 months (3382 patient-years), the incidence of both the primary combined endpoint of mortality/transplant (20% vs. 29%; logrank = 0.031) and ICD therapies (27% vs. 34%; p = 0.138) were lower in women. According to the propensity score-matching analysis, no differences were observed between both sexes with respect to the incidence of mortality/transplant (24.8% vs. 28.6%; logrank = 0.88), ICD therapies (28% vs. 27%; logrank = 0.17), and main cause of death (heart failure [HF]). Conclusions: The clinical characteristics at the moment of ICD implant are different between sexes. After adjusting them, both sexes equally benefit from the ICD. HF is the main cause of mortality both in men and women.

[Does the Tako-Tsubo syndrome need a certain coronary anatomy in the apical ventricular region as predisposing factor?]. / Precisa el síndrome Tako-Tsubo una anatomía coronaria en la región apical como sustrato predisponente?

The Tako-Tsubo transient left ventricular apical ballooning was born as a clinical profile in the year 2001. This syndrome occurs mainly in women older than 60 years and it is frequently preceded by a physical or emotional stress. Its presentation simulates a myocardial infarction, although with some differences: the pain is not always typical, and its intensity is moderate. The electrocardiogram reveals an elevation of ST in the anterior face in 90% of the cases; from the second day on, negative T waves in V2 through V6 leads are present, along with prolongation of the QTc interval. Enzymes are poorly elevated as expected from the electrical alterations. The alteration that defines the syndrome is the hypokinesis or akinesis of the apical segments with hyperkinesis of the basal ones. The main uncertainty of the Tako-Tsubo syndrome is its pathogenesis, its elucidation will provide advances in the practical handling of this syndrome2. We present the clinical case of a patient with this syndrome and a review of the existing medical literature on the possible association with a predisposing coronary anatomy in the apical segment.

Precisa el síndrome Tako-Tsubo una anatomía coronaria en la región apical como sustrato predisponente? / Does the Tako-Tsubo syndrome need a certain coronary anatomy in the apical ventricular region as predisposing factor?

The Tako-Tsubo transient left ventricular apical ballooning was born as a clinical profile in the year 2001. This syndrome occurs mainly in women older than 60 years and it is frequently preceded by a physical or emotional stress. Its presentation simulates a myocardial infarction, although with some differences: the pain is not always typical, and its intensity is moderate. The electrocardiogram reveals an elevation of ST in the anterior face in 90% of the cases; from the second day on, negative T waves in V2 through V6 leads are present, along with prolongation of the QTc interval. Enzymes are poorly elevated as expected from the electrical alterations. The alteration that defines the syndrome is the hypokinesis or akinesis of the apical segments with hyperkinesis of the basal ones. The main uncertainty of the Tako-Tsubo syndrome is its pathogenesis, its elucidation will provide advances in the practical handling of this syndrome2. We present the clinical case of a patient with this syndrome and a review of the existing medical literature on the possible association with a predisposing coronary anatomy in the apical segment.