Faculty Bibliography

BACKGROUND:Although prophylactic implantable cardioverter-defibrillator (ICD) implantation is beneficial in patients with severe ischemic cardiomyopathy, it is unclear whether patients with cardiomyopathy due to valvular heart disease have a similar benefit. METHODS:We followed 17 patients (14 men/three women, age 62 +/- 13 years, left ventricular ejection fraction [LVEF] 29 +/- 10%) who had nonischemic valvular cardiomyopathy, underwent valvular heart surgery (aortic valve replacement, mitral valve replacement, and/or mitral valve repair), and subsequently had an electrophysiology study (EPS), for a median of 2.8 years. These patients were compared with 34 patients with prior myocardial infarction and no significant valvular heart disease, who were matched (1:2) for age, gender, LVEF, EPS result, T-wave alternans result, and ICD placement. Occurrence of arrhythmias was ascertained from ICD device clinic follow-up and vital status was determined using the National Death Index. RESULTS:There were no differences between the groups in overall survival (P = 0.24) or arrhythmia-free survival (P = 0.38), and the 2-year arrhythmia-free survival was 82% for the valvular patients versus 73% for the ischemic patients. Among patients with ICDs, there was no difference between the groups in overall survival (P = 0.34), time to first appropriate ICD therapy (P = 0.54), and arrhythmia-free survival (P = 0.51). CONCLUSION/CONCLUSIONS:Patients with valvular cardiomyopathy and residual left ventricular dysfunction following valvular surgery who underwent a tailored approach to ICD implantation had similar overall and arrhythmia-free survival as patients with ischemic cardiomyopathy.

INTRODUCTION/BACKGROUND:Female gender has been associated with worse clinical outcomes following coronary revascularization. Whether a gender-specific difference in vessel size is contributing to this finding remains controversial. We sought to better define the relationship between gender and coronary artery size. METHODS:Baseline characteristics were obtained and quantitative coronary angiography was performed on 145 consecutive patients with angiographically normal (smooth luminal surface with no evidence of any irregularity in the coronary tree) coronary arteries. Two separate orthogonal measurements each were taken of the left main, proximal left anterior descending, proximal circumflex, proximal right coronary artery, and ostial posterior descending arteries. An average coronary size, derived from five separate coronary artery measurements, was tabulated for each patient. RESULTS:After correcting for confounding variables, including BSA, height, diabetes, and left ventricular hypertrophy using multivariate linear regression, female gender remained a strong independent predictor of coronary vessel size (Beta =-0.30, P = 0.004). Female gender was associated with a 0.30 mm decrease in average coronary size. CONCLUSION/CONCLUSIONS:Gender is a strong, independent predictor of coronary artery size even when taking into account differences in body size. This difference may contribute to worse outcomes of women undergoing coronary revascularization.