Left atrial size and function as assessed by computed tomography in cardiac resynchronization therapy: Association to
Peter Bomholt Hansen1, Anders Sommer2, Bjarne Linde Nørgaard2
1Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Skejby, DK-8200, Aarhus N, Denmark. Peterbomholt@hotmail.com.
Insights
Baseline left atrial (LA) size and function do not predict response to cardiac resynchronization therapy (CRT). While left ventricular (LV) remodeling is significant, LA reverse remodeling is minimal post-CRT.
Area of Science:
- Cardiology
- Medical Imaging
- Heart Failure Management
Background:
- Cardiac resynchronization therapy (CRT) is a key treatment for heart failure.
- Left atrial (LA) size and function are indicators of cardiovascular health.
- The impact of CRT on LA remodeling requires further investigation.
Purpose of the Study:
- To assess if baseline LA volume and function predict clinical or echocardiographic response to CRT.
- To evaluate LA reverse remodeling using computed tomography (CT) 6 months after CRT implantation.
Main Methods:
- Prospective study of 138 patients receiving CRT.
- Dynamic cardiac CT performed pre- and post-CRT for LA size and function assessment.
- Clinical response defined by NYHA class or 6-min walk test improvement; echocardiographic response by LV end-systolic volume reduction.
Main Results:
- No association found between baseline LA measures and CRT response (clinical or echocardiographic).
- Significant left ventricular (LV) end-systolic volume reduction of 35.2% observed.
- Marginal changes in LA volume (4.1-5.0% reduction) and no significant change in LA function post-CRT.
Conclusions:
- Baseline LA characteristics do not predict CRT response.
- CRT leads to significant LV reverse remodeling but only minor LA volume changes.
- LA function does not significantly improve after CRT despite LV remodeling.
Abstract:
To evaluate whether baseline left atrial (LA) volume and function were associated with clinical or echocardiographic response to cardiac resynchronization therapy (CRT), and to determine LA reverse remodeling as assessed by computed tomography (CT). We prospectively included patients receiving a CRT system who underwent dynamic cardiac CT with measurement of LA size and function before and 6 months after implantation. Patients alive not hospitalized for heart failure, and improving ≥1 NYHA class or ≥10% in 6-min walk test after 6 months follow-up were classified as clinical responders. Echocardiographic response was defined as ≥15% reduction in left ventricular (LV) end-systolic volume. We included 138 patients, of whom 95 (69%) were clinical responders and 114 (83%) were echocardiographic responders. We found no association between baseline measures of LA volume or function and clinical or echocardiographic response. Mean reduction in LA maximum and minimum volumes at 6 months were 3.3 ± 12.7 ml/m2 (p = 0.004) and 2.6 ± 11.4 ml/m2 (p = 0.01) corresponding to a relative reduction of 4.1 and 5.0%, respectively. LV end-systolic relative volume reduction was 35.2 ± 22.4% (p < 0.001). No measures of LA function changed significantly. Cardiac CT measures of baseline LA volume and function are not associated with clinical or echocardiographic response to CRT. Change in LA volume and function is marginal after 6 months despite pronounced LV reverse remodeling.
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