Atrial reverse remodelling is associated with outcome of cardiac resynchronization therapy(aEuro)

Marielle Kloosterman, Michiel Rienstra, Bart A. Mulder, Isabelle C. Van Gelder, Alexander H. Maass*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

14 Citations (Scopus)

Abstract

To study the prognostic effect of atrial reverse remodelling on outcome of cardiac resynchronization therapy (CRT).

Patients receiving a CRT device in the University Medical Centre Groningen were included. Atrial reverse remodelling was defined as a a parts per thousand yen10% 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 a parts per thousand yen15% 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).

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.

Original languageEnglish
Pages (from-to)1211-1219
Number of pages9
JournalEuropace
Volume18
Issue number8
Early online date30-Dec-2015
DOIs
Publication statusPublished - Aug-2016

Keywords

  • Cardiac resynchronization therapy
  • Reverse remodelling
  • Left atrial volume
  • Outcome
  • Diastolic dysfunction
  • HEART-FAILURE
  • EJECTION FRACTION
  • VOLUME INDEX
  • FIBRILLATION
  • MORTALITY
  • TRIAL
  • IMPROVEMENT
  • SIZE

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