title: Atrial reverse remodelling is associated with outcome of cardiac resynchronization therapy.
abstract: OBJECTIVE
  To study the prognostic effect of atrial reverse remodelling on outcome of cardiac resynchronization therapy (CRT).
  
  
  RESULTS
  Patients receiving a CRT device in the University Medical Centre Groningen were included. Atrial reverse remodelling was defined as a ≥10% reduction in left atrial volume index at 6-month follow-up. Success of CRT was defined as ventricular reverse remodelling with a reduction in left ventricular end-systolic volume of ≥15% at 6-month follow-up. Primary endpoint was all-cause mortality or heart failure hospitalizations. A total of 365 patients (mean age 65.1 ± 11.0 years, 73% men) were included; among them, 221 (61%) were in sinus rhythm and had no prior atrial fibrillation (AF), and 144 patients (39%) had a history of AF. During a mean follow up of 2.0 ± 1.0 years, 49 patients died. Cox regression analysis revealed that patients with no atrial and no ventricular reverse remodelling had the worst outcome (hazard ratio 3.1, 95% confidence interval 1.4-7.1, P = 0.006). Outcome in patients with only atrial reverse remodelling was comparable with outcome in patients with both atrial and ventricular reverse remodelling (hazard ratio 2.0, 95% confidence interval 0.7-5.6, P = 0.21).
  
  
  CONCLUSIONS
  Patients without atrial and ventricular reverse remodelling have the worst outcome. Patients with only atrial reverse remodelling have improved left ventricular diastolic filling during follow-up and demonstrate a comparable outcome with patients with both atrial and ventricular reverse remodelling. Assessment of atrial reverse remodelling may provide additional prognostic information in determining CRT outcome.
authors.affiliation: Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, Groningen RB 9700, The Netherlands.
authors.forename: Mariëlle
authors.initials: M
authors.lastname: Kloosterman
authors.affiliation: Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, Groningen RB 9700, The Netherlands.
authors.forename: Michiel
authors.initials: M
authors.lastname: Rienstra
authors.affiliation: Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, Groningen RB 9700, The Netherlands.
authors.forename: Bart A
authors.initials: BA
authors.lastname: Mulder
authors.affiliation: Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, Groningen RB 9700, The Netherlands.
authors.forename: Isabelle C
authors.initials: IC
authors.lastname: Van Gelder
authors.affiliation: Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, Groningen RB 9700, The Netherlands a.h.maass@umcg.nl.
authors.forename: Alexander H
authors.initials: AH
authors.lastname: Maass
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000628:therapy*; D064752:Atrial Remodeling; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D003971:Diastole; D004452:Echocardiography; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D012189:Retrospective Studies; D013318:Stroke Volume; D016896:Treatment Outcome; D020257:Ventricular Remodeling
keywords: Cardiac resynchronization therapy; Diastolic dysfunction; Left atrial volume; Outcome; Reverse remodelling