title: Left atrial remodeling and response to valsartan in the prevention of recurrent atrial fibrillation: the GISSI-AF echocardiographic substudy.
abstract: BACKGROUND
  Left atrial (LA) dilation precedes or appears early after the onset of atrial fibrillation (AF) and factors in perpetuating the arrhythmia. Angiotensin receptor blockers were proposed for reversing LA remodeling. We evaluated the effect of valsartan on LA remodeling in patients with a recent episode of AF and the effect of LA size on AF recurrence (AFr).
  
  
  RESULTS
  LA and left ventricular (LV) echocardiographic variables were measured at baseline and 6 and 12 months in 340 patients from GISSI-AF, a trial testing valsartan prevention of AFr. Reversal of remodeling was considered as a decrease in LA size over 12 months. Changes in patients with and without recurrence and the relationship to duration of AFr were analyzed. Patients were 68.4±8.8 years old, with history of hypertension (85.3%) and cardioversion in the previous 2 weeks (87.4%) or ≥2 AFr in the previous 6 months (40.4%). Baseline LA maximal volume (LAVmax) was severely increased (>40 mL/m(2)); LV dimensions and function were relatively normal. Over 12 months, 54.4% of patients had AFr. LAVmax was unchanged by rhythm, time, or randomized treatment. Higher baseline LAVmax and lower LA emptying fraction were linearly related to increasing AFr duration during follow-up.
  
  
  CONCLUSIONS
  GISSI-AF patients in sinus rhythm and history of AF showed severely increased LAVmax with mostly normal LV volume, mass, and systolic and diastolic function. Valsartan for 1 year did not reverse LA remodeling or prevent AFr. Half of the patients without AFr had severe LA dilation; therefore, mechanisms other than structural remodeling triggered recurrence.
authors.affiliation: Department of Cardiovascular Research, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy. lidia.staszewsky@marionegri.it
authors.forename: Lidia
authors.initials: L
authors.lastname: Staszewsky
authors.forename: Maylene
authors.initials: M
authors.lastname: Wong
authors.forename: Serge
authors.initials: S
authors.lastname: Masson
authors.forename: Elena
authors.initials: E
authors.lastname: Raimondi
authors.forename: Silvana
authors.initials: S
authors.lastname: Gramenzi
authors.forename: Gianni
authors.initials: G
authors.lastname: Proietti
authors.forename: Dario
authors.initials: D
authors.lastname: Bicego
authors.forename: Carlo
authors.initials: C
authors.lastname: Emanuelli
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Pulitanò
authors.forename: Filippo
authors.initials: F
authors.lastname: Taddei
authors.forename: Enrico B
authors.initials: EB
authors.lastname: Nicolis
authors.forename: Ernesto
authors.initials: E
authors.lastname: Correale
authors.forename: Gianna
authors.initials: G
authors.lastname: Fabbri
authors.forename: Federico
authors.initials: F
authors.lastname: Bertocchi
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Franzosi
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
authors.forename: Gianni
authors.initials: G
authors.lastname: Tognoni
authors.forename: Marcello
authors.initials: M
authors.lastname: Disertori
authors.forename: Roberto
authors.initials: R
authors.lastname: Latini
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D047228:Angiotensin II Type 1 Receptor Blockers / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D016279:Atrial Function, Left / Q000187:drug effects*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D020127:Recovery of Function; D018570:Risk Assessment; D055502:Secondary Prevention; D012720:Severity of Illness Index; D015996:Survival Rate; D013777:Tetrazoles / Q000008:administration & dosage*; D016896:Treatment Outcome; D014633:Valine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000068756:Valsartan
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D013777:Tetrazoles; D000068756:Valsartan; D014633:Valine