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Published on: July 14, 2021
Left Atrial Reverse Remodeling in Dilated Cardiomyopathy
Vincenzo Nuzzi1, Anne Raafs2, Paolo Manca1
1Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy.
Insights
Reducing left atrial volume index (LAVI) in patients with dilated cardiomyopathy (DCM) is linked to better outcomes. A significant decrease in LAVI over one year correlated with a lower risk of death, heart transplantation, or heart failure hospitalization.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Heart Failure Research
Background:
- Left atrial (LA) dilation is a known negative prognostic factor in cardiovascular disease.
- Therapeutic interventions can induce LA reverse remodeling.
- The prognostic significance of LA volume index (LAVI) reduction in dilated cardiomyopathy (DCM) requires characterization.
Purpose of the Study:
- To characterize LAVI reduction in patients with DCM.
- To define the prognostic implications of LAVI reduction in DCM patients.
- To investigate the association between LAVI changes and adverse cardiovascular outcomes.
Main Methods:
- Retrospective analysis of 560 DCM patients from two centers with baseline and 1-year echocardiograms.
- LA dilation defined as LAVI > 34 mL/m²; 1-year relative LAVI reduction (ΔLAVI) calculated.
- Composite outcome: death, heart transplantation (HTx), or heart failure hospitalization (HFH).
Main Results:
- Baseline LAVI showed a non-linear association with adverse outcomes, independent of other factors (P < .01).
- 67% of patients achieved LAVI reduction (median ΔLAVI, -24%) at 1 year; higher baseline LAVI and lower LVEF predicted reduction.
- ΔLAVI demonstrated a linear association with reduced risk of death, HTx, or HFH (HR, 0.96 per 5% decrease; P = .042).
- LAVI normalization (≤34 mL/m²) or >10% reduction was associated with significantly lower risk (HR, 0.37; P = .028).
Conclusions:
- One-year LAVI reduction is achievable in a significant proportion of DCM patients.
- LA structural reverse remodeling, indicated by LAVI reduction, may serve as a valuable tool for risk stratification in DCM.
- Monitoring LAVI changes can aid in individualized risk assessment and management of DCM patients.
Background:
Left atrial (LA) dilation is associated with a worse prognosis in several cardiovascular settings, but therapies can promote LA reverse remodeling. The aim of this study was to characterize and define the prognostic implications of LA volume index (LAVI) reduction in patients with dilated cardiomyopathy (DCM).
Methods:
Consecutive patients with DCM from two tertiary care centers, with available echocardiograms at baseline and at 1-year follow-up, were retrospectively analyzed. LA dilation was defined as LAVI > 34 mL/m2, and change in LAVI (ΔLAVI) was defined as the 1-year relative LAVI reduction. The outcome was a composite of death, heart transplantation (HTx), or heart failure hospitalization (HFH).
Results:
Five hundred sixty patients were included (mean age, 54 ± 13 years; mean left ventricular ejection fraction, 31 ± 10%; mean LAVI, 45 ± 18 mL/m2). Baseline LAVI had a non-linear association with the risk for death, HTx, or HFH, independent of age, left ventricular ejection fraction, mitral regurgitation, and medical therapy (P < .01). At 1-year follow-up, LAVI decreased in 374 patients (67%; median ΔLAVI, -24%; interquartile range, -37% to -11%). Factors independently associated with ΔLAVI were higher baseline LAVI and lower baseline left ventricular ejection fraction. After multivariable adjustment, ΔLAVI showed a linear association with the risk for death, HTx, or HFH (hazard ratio, 0.96 per 5% decrease; 95% CI, 0.93-0.99; P = .042). At 1-year follow-up, patients with reductions in LAVI of >10% and LAVI normalization (i.e., follow-up LAVI ≤ 34 mL/m2; 31% of the overall cohort) were at lower risk for death, HTx, or HFH (hazard ratio, 0.37; 95% CI, 0.35-0.97; P = .028).
Conclusions:
In a large cohort of patients with DCM, 1-year reduction in LAVI was observed in a number of patients. The association between reduction in LAVI and death, HTx, or HFH suggests that LA structural reverse remodeling might be considered an additional parameter useful in the individualized risk stratification of patients with DCM.
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