title: Left atrial function, a new predictor of response to cardiac resynchronization therapy?
abstract: BACKGROUND
  Cardiac resynchronization therapy (CRT) improves left ventricular (LV) function and induces LV remodeling, and it is an established therapy for advanced heart failure with prolonged QRS duration. One third of patients will not benefit from this invasive therapy.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate whether left atrial (LA) strain imaging (ε) parameters could help in predicting the response in terms of LV reverse remodeling after CRT.
  
  
  METHODS
  A total of 79 patients who underwent CRT were evaluated with echography before implantation. LA function and LV function were assessed with M-mode, 2-dimensional echocardiography, Doppler, tissue Doppler velocity, and ε. LV reverse remodeling was defined as a >15% reduction in LV end-systolic volume.
  
  
  RESULTS
  At 6 months, 54 patients (68%) were responders to CRT. In multivariable logistic regression, LA systolic peak of strain rate (SRA) (odds ratio [OR} 10.5, 95% confidence interval [CI] 1.76-62.1, P = .01), left bundle branch block (OR 6.8, 95% CI 1.06-43.9, P = .04), ischemic cardiomyopathy (OR 3.93, 95% CI 1.07-14.4, P = .04), and LV preejection index (OR 1.03, 95% CI 1.01-1.05, P = .01) were associated with CRT response. With an SRA cutoff of -0.75%, the negative predictive value for predicting CRT response was 0.62.
  
  
  CONCLUSIONS
  This study demonstrated the possible relevance of assessing LA function before CRT. SRA appeared to be a good predictor of CRT response. Integrating this LA function analysis into the multivariable assessment of patient candidates for CRT should be considered.
authors.affiliation: Cardiologie et CIC-IT U 804, Centre Hospitalier Universitaire de Rennes, Rennes, France; LTSI, Université Rennes, INSERM 1099, Rennes, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Feneon
authors.affiliation: Cardiologie et CIC-IT U 804, Centre Hospitalier Universitaire de Rennes, Rennes, France; LTSI, Université Rennes, INSERM 1099, Rennes, France.
authors.forename: Albin
authors.initials: A
authors.lastname: Behaghel
authors.affiliation: LTSI, Université Rennes, INSERM 1099, Rennes, France,; Service de Cardiologie, CHU Tours, Tours, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Bernard
authors.affiliation: Cardiologie et CIC-IT U 804, Centre Hospitalier Universitaire de Rennes, Rennes, France; LTSI, Université Rennes, INSERM 1099, Rennes, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Fournet
authors.affiliation: Cardiologie et CIC-IT U 804, Centre Hospitalier Universitaire de Rennes, Rennes, France; LTSI, Université Rennes, INSERM 1099, Rennes, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Mabo
authors.affiliation: Cardiologie et CIC-IT U 804, Centre Hospitalier Universitaire de Rennes, Rennes, France; LTSI, Université Rennes, INSERM 1099, Rennes, France.
authors.forename: J-Claude
authors.initials: JC
authors.lastname: Daubert
authors.affiliation: Cardiologie et CIC-IT U 804, Centre Hospitalier Universitaire de Rennes, Rennes, France; LTSI, Université Rennes, INSERM 1099, Rennes, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Leclercq
authors.affiliation: Cardiologie et CIC-IT U 804, Centre Hospitalier Universitaire de Rennes, Rennes, France; LTSI, Université Rennes, INSERM 1099, Rennes, France,. Electronic address: erwan.donal@chu-rennes.fr.
authors.forename: Erwan
authors.initials: E
authors.lastname: Donal
mesh_terms: D000368:Aged; D016279:Atrial Function, Left; D002037:Bundle-Branch Block / Q000150:complications; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D058409:Cardiac Resynchronization Therapy Devices; D009202:Cardiomyopathies / Q000150:complications; D004452:Echocardiography / Q000379:methods; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
keywords: Cardiac resynchronization therapy; Echocardiography; Left atrial function; Strain imaging