Heart failure & cardiomyopathies
Left Atrial Reverse Remodeling in Patients Supported With Durable Left Ventricular Assist Devices and Clinical Implications
Authors' conclusion
LA structure and function improved early post-LVAD support, showed stability of improvement during follow-up, and were associated with simultaneous LV changes. Implications on all-cause mortality and AF might inform the care of heart failure patients being considered for advanced therapies, as well as the broader population of patients with heart failure and concomitant AF undergoing pharmacological unloading.
Study context
- Population
- Consecutive patients with advanced heart failure receiving durable, continuous-flow LV assist devices (LVADs)studied after excluding patients with unavailable echocardiographic data, n=263 prospectively evaluated
- Participants
- 241 patients
- Exposure
- Left atrium (LA) structure and function pre- vs post-LVAD implantation, and the magnitude of LA reverse remodeling against clinical outcomes
- Outcome
- Baseline characteristics
- Follow-up
- Pre-LVAD
Methodological detailsserial echocardiographic assessment pre- and post-LVAD implantation
- Serial echocardiographic assessment pre- and post-LVAD implantation
Main finding
As reported in the abstract
- Mean age
- 56±15 years
- Underlying ischemic cardiomyopathy
- Forty-four percent
- INTERMACS profile 1 to 3
- 65%
- Mean left ventricle (LV) ejection fraction
- 19±7%
- End-diastolic diameter
- 6.7±1.1 cm
Observational data: associations, not effects.
Further findings
LA structure and function · 1 month and 12 months on LVAD support
- Improved by 1 month and remained improved by 12 months (LA volumes, emptying volumes, emptying fractions, strain parameters)
Association of LA changes with LV changes
- LA changes associated with LV structural and functional changes
Magnitude of LA reverse remodeling and clinical outcomes · 12 months on LVAD support
- Associated with all-cause mortality
- Not associated with cerebrovascular accident/transient ischemic attack, LVAD thrombosis, or late right heart failure rates
Rhythm among the 46 patients with atrial fibrillation (AF) pre-LVAD · during serial echocardiographic assessment
- Of 46 with AF pre-LVAD, converted to sinus rhythm
- 28 (61%)
- Of 46 with AF pre-LVAD, remained in AF
- 18 (39%)
Original publication
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