HFSA ePoster Library

There remains significant anecdotal evidence to suggest that gender is a contributing factor in the presentation, prognosis and survival of heart disease. Within ischemic cardiomyopathy, current studies have indicated that female sex may be an independent risk factor for increased in-hopsital mortality[1-2]. Although females typically have a later presentation with atypical chest pain and symptoms, their survival, bridge to recovery and transplantation are less well characterized compared to males[3]. We aimed to compare all-cause mortality among male and female patients who underwent Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) as a bridge to treatment. This study represents the first to evaluate gender differences in prognosis of cardiogenic shock in the setting of ischemic cardiomyopathy (ICM) on mechanical circulatory support.
A retrospective single-institutional study collected all consecutive non-pediatric patients who underwent VA ECMO for acute cardiogenic shock between 2016-2020 with a total of 418 patients. This cohort was further divided into ischemic versus nonischemic cardiomyopathy of which 232 (55.5%) were classified as (ICM). Univariate and multivariate analyses were performed. The risk factors affecting survival to hospital discharge were determined by multiple logistic regression analysis.
The age at time of ECMO was not statistically different between female v. male at 53.6 v. 56.5 (p <0.071). There were 283 (68%), 41 (9.9%), and 3 (0.7%) patients that were white, black, and other, respectively. A total of 135 (32.3%) were female in our cohort with a statistically significant smaller Body Surface Area (BSA), at 1.95 vs. 2.17 (p < .001). There was no significant difference between Genders in ECMO outcome (p = .448) for the entire cohort. On assessment of inability to wean off ECMO, there was no statistical significance between both genders (p = .197). Among patients with a diagnosis of ICM, there were no significant differences comparing outcomes of both sex (p = 0.181).
Our study showed that women with ischemic cardiomyopathy in the setting of acute cardiogenic shock placed on VA-ECMO do not have worse outcomes compared to that of men. In this study, observed-to-expected rates of females matched those of males regarding ability to wean off ECMO, bridge to intracorporeal mechanical devices and/or to heart transplantation. In this cohort, we observed that women were similar in age, although smaller in body size with similar proportions of NICM to ICM etiologies. Anecdotal differences in outcomes cannot be explained by age, body habitus, race or etiology. Additional research is required to investigate outcomes of females with ischemic cardiomyopathy.
Although observed-to-expected rates of ECMO outcomes in females were not significantly different than those of males, differences in outcomes cannot be explained by age, body habitus, race or cardiac etiology. This suggests that differences are not universal and may vary per patient.