Left Atrial Reverse Remodeling in Dilated Cardiomyopathy

• Published in: Journal of the American Society of Echocardiography Vol. 36; no. 2; pp. 154 - 162
• Main Authors: Nuzzi, Vincenzo, Raafs, Anne, Manca, Paolo, Henkens, Michiel T.H.M., Gregorio, Caterina, Boscutti, Andrea, Verdonschot, Job, Hazebroek, Mark, Knackstedt, Christian, Merlo, Marco, Stolfo, Davide, Sinagra, Gianfranco, Heymans, Stephane R.B.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2023
• Subjects: Adult; Aged; Atrial Fibrillation; Atrial Remodeling; Cardiomyopathy, Dilated - diagnostic imaging; Cardiovascular; Clinical outcome; Dilated cardiomyopathy; Heart Atria - diagnostic imaging; Heart failure; Humans; Left atrial reverse remodeling; Left atrium; Middle Aged; Prognosis; Retrospective Studies; Stroke Volume; Ventricular Function, Left; Heart failure; CRT; AF; MR; LVEF; LV; Left atrium; HFH; LAVI; HFrEF; HTx; Left atrial reverse remodeling; DCM; Clinical outcome; Dilated cardiomyopathy; LA; LARR; HF; Heart failure hospitalization; Left ventricular; Heart failure with reduced ejection fraction; Cardiac resynchronization therapy; Left atrial volume index; Left ventricular ejection fraction; Atrial fibrillation; Heart transplantation; Mitral regurgitation; Left atrial
• DOI: 10.1016/j.echo.2022.10.017
• ISSN: 0894-7317; 1097-6795

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). 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). 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). 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. [Display omitted] •LA dilation is associated with poor outcomes in HF and DCM.•Therapies can promote LARR.•A significant proportion of patients with DCM show LARR over 1-year follow-up.•LARR is strongly associated with lower risk for poor prognosis.