title: Left atrial reverse remodeling in dogs with moderate and advanced heart failure treated with a passive mechanical containment device: an echocardiographic study.
abstract: BACKGROUND
  Assessment of global left ventricular (LV) remodeling is important in evaluating the efficacy of pharmacologic and device therapies for the treatment of chronic heart failure (HF). The effects of pharmacologic or device therapies on global left atrial (LA) remodeling in HF, although also important, are not often examined. We showed that long-term therapy with the Acorn Cardiac Support Device (CSD), a passive mechanical ventricular containment device, prevents or reverses LV remodeling in dogs with HF. This study examined the effects of the CSD on global LA remodeling in dogs with moderate and advanced HF.
  
  
  RESULTS
  Studies were performed in 24 dogs with coronary microembolization-induced HF. Of these, 12 had moderate HF (ejection fraction, EF 30% to 40%) and 12 advanced HF (EF < or = 25%). In each group, the CSD was implanted in 6 dogs and the other 6 served as controls. Dogs were followed for 3 months in the moderate group and 6 months in the advanced HF group. LA maximal volume (LAVmax), LA volume at the onset of the p-wave (LAVp), LA minimal volume (LAVmin), LA active emptying volume (LAAEV), and LA active emptying fraction (LAAEF) were measured from 2-dimensional echocardiograms obtained before CSD implantation and at the end of the treatment period. Treatment effect (delta) comparisons between CSD-treated dogs and controls showed that CSD therapy significantly decreased LA volumes (deltaLAVmax: 3.33 +/- 0.70 vs. -2.87 +/- 1.31 mL, P = .002; 7.77 +/- 1.76 versus -0.37 +/- 0.87 mL, P = .002) and improved LA function (deltaLAAEF: -6.00 +/- 1.53 versus 1.85 +/- 1.32%, P = .003; -2.39 +/- 1.10 versus 3.13 +/- 1.66%, P = .02) in the moderate HF and advanced HF groups, respectively.
  
  
  CONCLUSIONS
  Progressive LA enlargement and LA functional deterioration occurs in untreated dogs with HF. Monotherapy with the CSD prevents LA enlargement and improves LA mechanical function in dogs with moderate and advanced HF indicating prevention or reversal of adverse LA remodeling.
authors.affiliation: Department of Medicine, Division of Cardiovascular Medicine, Henry Ford Heart & Vascular Institute, Detroit, Michigan 48202, USA.
authors.forename: Valerio
authors.initials: V
authors.lastname: Zacà
authors.forename: Robert
authors.initials: R
authors.lastname: Brewer
authors.forename: Sanjaya
authors.initials: S
authors.lastname: Khanal
authors.forename: Makoto
authors.initials: M
authors.lastname: Imai
authors.forename: Alice
authors.initials: A
authors.lastname: Jiang
authors.forename: Mengjun
authors.initials: M
authors.lastname: Wang
authors.forename: Sidney
authors.initials: S
authors.lastname: Goldstein
authors.forename: Hani N
authors.initials: HN
authors.lastname: Sabbah
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D004285:Dogs; D004452:Echocardiography / Q000379:methods; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices; D016896:Treatment Outcome