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Clinical implications of left atrial changes after optimization of medical therapy in patients with heart failure

Riccardo M Inciardi1, Matteo Pagnesi1, Carlo M Lombardi1

  • 1Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.

European Journal of Heart Failure
|June 24, 2022
PubMed

Insights

Changes in left atrial size indicate heart failure prognosis. Left atrial adverse remodeling predicts poor outcomes but can be prevented by optimizing ACEi/ARB therapy, improving risk stratification.

Area of Science:

  • Cardiology
  • Echocardiography
  • Heart Failure Research

Background:

  • Limited data exist on the prognostic value of left atrial (LA) dimension changes in heart failure (HF).
  • Assessing LA dimension changes after guideline-directed medical therapy (GDMT) optimization is crucial for understanding HF progression.

Purpose of the Study:

  • To evaluate the prognostic relevance of changes in left atrial (LA) dimensions.
  • To investigate the relationship between LA dimension changes and outcomes after optimizing guideline-directed medical therapy (GDMT) in heart failure (HF) patients.

Main Methods:

  • 632 patients with new-onset or worsening HF were assessed for LA diameter at baseline and 9 months post-GDMT optimization.
  • Left atrial adverse remodeling (LAAR) was defined as increased LA diameter; patients were followed for a median of 13 months.
  • Statistical analyses included logistic regression for LAAR predictors and Cox proportional hazards models for outcome associations.

Main Results:

  • Left atrial adverse remodeling (LAAR) occurred in 39% of patients.
  • Larger baseline LA diameter and up-titration of ACEi/ARBs were associated with a lower likelihood of LAAR.
  • LAAR was linked to a significantly increased risk of all-cause mortality or HF hospitalization (aHR 1.73).

Conclusions:

  • Left atrial adverse remodeling (LAAR) is associated with unfavorable outcomes in heart failure (HF) patients.
  • Up-titration of ACEi/ARBs can prevent LAAR, suggesting a role in mitigating adverse events.
  • Changes in LA dimension serve as a valuable marker for treatment response and risk stratification in HF.
Abstract

Keywords:
Guideline-directed medical therapyHeart failureLeft atrium

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