Left atrial volume index predicts response to cardiac resynchronisation therapy: a systematic review and
Ibadete Bytyçi1,2,3, Gani Bajraktari1,2,4, Michael Y Henein1,5
1Institute of Public Health and Clinical Medicine, Umeå University, Sweden.
Insights
Lower baseline left atrial volume index (LAVI) predicts a positive response to cardiac resynchronisation therapy (CRT). Reduction in LAVI post-CRT indicates cardiac remodelling and improved left ventricular function.
Area of Science:
- Cardiology
- Medical Imaging
- Heart Failure Management
Background:
- Cardiac resynchronisation therapy (CRT) improves left ventricular (LV) function and reduces atrial arrhythmias in responders.
- Left atrial (LA) volume is a potential indicator of cardiac function and response to therapy.
Purpose of the Study:
- To evaluate the relationship between left atrial volume index (LAVI) and CRT response.
- To determine if baseline LAVI can predict CRT outcomes.
Main Methods:
- Systematic search of electronic databases up to August 2018 for relevant clinical trials and observational studies.
- Meta-analysis of 10 studies including 2191 patients to assess the predictive value of LAVI for CRT response.
- Defined CRT response by a reduction in LV end-systolic volume (LVESV) ≥ 15 ml and/or an increase in LV ejection fraction (LVEF) ≥ 10%.
Main Results:
- CRT responders exhibited significantly lower baseline LAVI compared to non-responders (WMD -5.89%, p < 0.001).
- LAVI decreased in CRT responders post-therapy (WMD -4.36%, p < 0.001) but increased in non-responders (WMD 1.45%, p = 0.20).
- A baseline LAVI < 34 ml/m² demonstrated high sensitivity (0.80%) and specificity (0.74%) in predicting CRT response, with an odds ratio > 11.
Conclusions:
- Baseline LAVI is a significant predictor of CRT response.
- Reduction in LAVI post-CRT suggests beneficial LA remodelling and improved cardiac function.
- LAVI assessment should be integrated into the evaluation of cardiac function response to CRT.
Introduction:
In responders, cardiac resynchronisation therapy (CRT) results in improved left ventricular (LV) function and reduced atrial arrhythmia. The aim of this meta-analysis was to assess the potential relationship between the left atrium (LA) volume and CRT response.
Material And Methods:
We systematically searched all electronic databases up to August 2018 in order to select clinical trials and observational studies that assessed the predictive value of LA volume index (LAVI) of CRT response. Left ventricular end-systolic volume (LVESV) reduction ≥ 15 ml and/or LV ejection fraction (EF) increase ≥ 10% were the documented criteria for positive CRT response.
Results:
A total of 2191 patients recruited in 10 studies with mean follow-up duration of 10.5 months were included in this meta-analysis. The pooled analysis showed that CRT responders had lower baseline LAVI compared to non-responders, with a weighted mean difference (WMD) of -5.89% (95% CI: -9.47 to -3.22, p < 0.001). At follow-up, LAVI fell in the CRT responders (WMD -4.36%, 95% CI: -3.54 to -5.17, p < 0.001) compared to non-responders (WMD 1.45 %, 95% CI: -0.75 to 3.65, p = 0.20). The mean change of LAVI in the CRT responders was related to the fall in LVESV, β = -1.02 (-1.46 to -0.58), p < 0.001 and the increase in LVEF, β = 2.02 (1.86 to 4.58), p = 0.001. A baseline LAVI < 34 ml/m2 predicted CRT response with summary sensitivity 0.80% (0.53-0.95), specificity 0.74% (0.53-0.89), and odds ratio > 11.
Conclusions:
Baseline LAVI predicts CRT response, and its reduction reflects devise-related LA remodelling. These results emphasis the role of LAVI assessment as an integral part of cardiac function response to CRT.
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