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Implantable defibrillators in ischaemic cardiomyopathy: should women be treated differently to men?
  1. Dominic Y Leung
  1. Correspondence to Professor Dominic Leung, Department of Cardiology, University of New South Wales, Sydney, Australia, Liverpool Hospital, Locked Bag, 7103, Liverpool BC, NSW 1871, Australia; d.leung{at}unsw.edu.au

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Gender differences in the presentations, investigations, management and outcomes in cardiovascular diseases have attracted much attention and, to a certain extent, controversies. It is perhaps an exaggeration to say that men are from Mars and women are from Venus, nevertheless, there are notable differences between men and women as far as cardiovascular conditions are concerned. Women are less likely to undergo appropriate coronary angiography and percutaneous interventions post myocardial infarction with significant differences in outcomes. Gender differences have also been noted in heart failure with regard to underlying aetiologies, pathophysiology and prognosis.1 Women are under-represented in randomised clinical trials, including heart failure1 and device therapy trials.2 Meta-analyses of implantable cardioverter-defibrillator (ICD) trials showed that women constituted only a low 8–33% of the study population. While some meta-analyses of ICD trials found that men, but not women, derived mortality benefits,3–5 others did not come to the same conclusions.6

In addition to documented ventricular tachyarrhythmias, New York Heart Association functional class and LV EF are the only established, albeit imprecise,8 indications for ICD therapy in patients with LV systolic dysfunction. Delayed hyperenhancement cardiac magnetic resonance (DHE-CMR) can accurate identify myocardial viability and scar tissues with high spatial and contrast resolution. Total scar burden, as well as location and transmurality of myocardial scars can be reliably and reproducibly quantified. Total myocardial scar burden has been shown to be an independent predictor of total mortality or cardiac transplantation or appropriate ICD therapies in retrospective series.9–11 However, DHE-CMR has not been used …

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