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Predictive value of left atrial remodeling for response to cardiac resynchronization therapy

Sjoerd Bouwmeester1, Thomas Mast1, Frits Prinzen2, Lukas Dekker1, Patrick Houthuizen1

Affiliation and address for correspondence
J Ultrason 2022; 22: e168–e173
DOI: 10.15557/JoU.2022.0027
Abstract

Aim: Response to cardiac resynchronization therapy varies significantly among patients, with one third of them failing to demonstrate left ventricular reverse remodeling after cardiac resynchronization therapy. Left atrial size and function is increasingly recognized as a marker of disease severity in the heart failure population. The aim of this study was to evaluate whether echocardiographic left atrial indices predict left ventricular reverse remodeling after cardiac resynchronization therapy. Materials and methods: Ninety-nine cardiac resynchronization therapy candidates were prospectively included in the study and underwent echocardiography before and 3-months after cardiac resynchronization therapy implantation. Cardiac resynchronization therapy response was defined as a 15% relative reduction in left ventricular end-systolic volume. Indexed left atrial volume, left atrial reservoir strain, left ventricular end-diastolic volume, and left ventricular ejection fraction along with other known predictors of cardiac resynchronization therapy response (gender, etiology of heart failure, presence of typical left bundle branch block pattern, QRS duration >150 ms) were included in a multivariate logistic regression model to identify predictors for cardiac resynchronization therapy response. Results: Cardiac resynchronization therapy response occurred in n = 63 (64%) patients. The presence of a typical left bundle branch block (OR 4.2, 95 CI: 1.4–12.1, p = 0.009), QRS duration >150 ms (OR 4.2, 95 CI: 1.4–11.0, p = 0.029), and left atrial volume index (OR: 0.6, 95 CI: 0.4–0.9, p = 0.012) remained the only significant predictors for cardiac resynchronization therapy response after three months. None of the baseline left ventricular parameters showed an independent predictive value. Conclusion: Left atrial size at baseline is an independent predictor and is inversely proportional to left ventricular volumetric reverse remodeling in cardiac resynchronization therapy candidates.

Keywords
heart failure, cardiac resynchronization therapy, left atrial remodeling, left atrial strain, left ventricular reverse remodeling