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Left atrial reverse remodeling predicts long-term survival after cardiac resynchronization therapy

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Abstract

Background

Left ventricular (LV) reverse remodeling has been identified as a strong predictor of long-term survival in patients receiving CRT. Interestingly, CRT induces reverse remodeling in the left atrium (LA) as well. It is currently unknown to what extent LA reverse remodeling is correlated to long-term survival after CRT. This study aims to assess the long-term prognostic value of left atrium (LA) reverse remodeling in patients undergoing cardiac resynchronization therapy (CRT).

Methods

Baseline and 3-months follow-up echocardiograms after CRT implantation were prospectively assessed to determine changes in left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), left atrial volume (LAV), and left atrial reservoir strain (LASr). Multivariate Cox regression analysis was performed to identify predictors for long-term survival.

Results

In our study population of 99 patients with a mean follow-up of 6.3 ± 2.1 years, 43 patients (43%) reached the end-point of all-cause mortality. More extensive LA reverse remodeling, as measured by a relative increase in LASr, was observed in survivors compared to non-survivors (43 [29–64] % vs. 8 [2–28] %, P < 0.001, respectively). After multivariate analysis, delta LASr remained the only significant predictor of mortality [HR per 5%: 0.90 (0.86–0.95); AUC 0.78 (0.68–0.88)].

Conclusion

An increase in LASr is associated with favorable long-term outcome after CRT. The observed clinical importance of LA reverse remodeling after CRT asks for further validation in larger prospective cohorts.

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Funding

Dutch Heart Foundation, Dekker student grant, Grant Number: 2015SB007.

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Author notes

  1. Sjoerd Bouwmeester and Thomas P. Mast contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands

    Sjoerd Bouwmeester, Thomas P. Mast, Daniëlle C. J. Keulards, Anouk G. W. de Lepper, Lukas R. Dekker & Patrick Houthuizen

  2. Department of Anesthesiology and Intensive Care, Catharina Hospital, Eindhoven, The Netherlands

    Ingeborg H. F. Herold

  3. Department of Electrical Engineering, Technical University, Eindhoven, The Netherlands

    Lukas R. Dekker

  4. Department of Physiology, School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands

    Frits W. Prinzen

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  1. Sjoerd Bouwmeester
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Correspondence to Sjoerd Bouwmeester.

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Conflict of interest

Sjoerd Bouwmeester, Thomas P Mast, Daniëlle C J Keulards, Anouk G W de Lepper, Ingeborg H F Herold, Lukas Dekker, and Patrick Houthuizen declare that they have no conflict of interest. Frits W Prinzen has received research grants from Medtronic, Abbott, Biotronik, and Microport CRM.

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Bouwmeester, S., Mast, T.P., Keulards, D.C.J. et al. Left atrial reverse remodeling predicts long-term survival after cardiac resynchronization therapy. J Echocardiogr 20, 115–123 (2022). https://doi.org/10.1007/s12574-021-00559-0

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  • DOI: https://doi.org/10.1007/s12574-021-00559-0

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