Objective
: We aimed to assess the impact of gender on long-term prognosis in pts with known or suspected CAD and impaired vs. preserved left ventricular (LV) function assessed by means of gated myocardial perfusion SPECT (gSPECT).
Methods
. 575 consecutive pts (38% women, mean age 66±12 yrs;43% pharmacological stress) had rest/stress gSPECT and were then followed up for 11±1 yrs. 55 pts (9.6%) had severe LV dysfunction (post-stress LVEF≥35%). Follow-up end-point was all-cause death (ACD). Prognostic value of clinical and gSPECT variables in predicting ACD was assessed by multivariable Cox proportional hazards analysis. We also evaluated tested variables for presence of confounding and interactions.
Results
. During the follow-up, there were 143 ACD events (24.9%). Compared to men, women were younger, had less severe perfusion defects, higher LVEF, and smaller LV volumes. There was as a significant interaction between female gender and LV function; survival of women with LVEF≥35% was significantly worse compared to men with the same level of LV impairment, even after adjustment for all other significant predictors, such as age, perfusion defect extent/severity, abnormal ECG, rest HR, dyspnea, history of known CAD and diabetes. (Figure
; *p<0.001). No difference found among the male and female pts with LVEF>35%.
Conclusion
: In pts with severe LV dysfunction (within the so-called “AICD range”), female gender is associated with worse long term prognosis, independent of other prognostic markers and despite more favorable clinical profile. If confirmed in prospective studies, these findings may have important clinical implications in management of pts with severe LV impairment.
The expanding role of left ventricular functional assessment using gated myocardial perfusion SPECT: the supporting actor is stealing the scene
