Left atrial reverse remodeling and cardiac resynchronization therapy for chronic heart failure patients in sinus rhythm.
BACKGROUND
Cardiac resynchronization therapy (CRT), which improves left ventricular (LV) function and reverses LV remodeling, is an established therapy for advanced heart failure with prolonged QRS duration. The aim of this study was to examine whether CRT improves atrial function and induces atrial reverse remodeling.


METHODS
A total of 46 patients with heart failure (mean age, 66.7 +/- 10.4 years) who underwent CRT were evaluated with echocardiography before and after 6 months of optimized CRT. Atrial function and LV function were assessed with M-mode, two-dimensional echocardiography, Doppler, tissue Doppler velocity, and strain (epsilon) imaging. LV reverse remodeling was defined as a reduction in LV end-systolic volume of >15%.


RESULTS
In responders (n = 23), significant improvements in left atrial (LA) functional, structural, and anatomic remodeling were observed. Maximum LA area and volume decreased, the LA emptying fraction increased, A' increased, and LA epsilon increased from 25.6 +/- 11.0% to 42.6 +/- 10.4% (P < .05 overall). LA reverse remodeling was correlated with baseline LA volume (R = 0.45). Although the correlation was not significant (r = 0.24), LA reverse remodeling was also more frequent in patients with LV reverse remodeling.


CONCLUSIONS
In patients with LV remodeling, significant LA reverse remodeling after CRT could be observed and detailed on transthoracic echocardiography.
Donal
Erwan
E
Service de Cardiologie, CIC-IT INSERM U 642, CHU Rennes, Rennes, France. erwan.donal@chu-rennes.fr
Tan
Kannika
K
Leclercq
Christophe
C
Ollivier
Romain
R
Derumeaux
Genevieve
G
Bernard
Mathieu
M
de Place
Christian
C
Mabo
Philippe
P
Daubert
Jean-Claude
JC
D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D002908:Chronic Disease; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging* / Q000517:prevention & control*