Key result
Normal pre-CRT left atrial pressure is linked to ~17% greater LVESV reduction versus elevated pressure.
Why the study?
The study investigated the impact of baseline left atrial strain and estimated left atrial pressure using 2016 ASE/EACVI guidelines on cardiac resynchronization therapy outcomes.
Does normal estimated left atrial pressure predict improved LV reverse remodeling and survival in heart failure patients receiving cardiac resynchronization therapy?
Observational (n=219)
No
Does normal estimated left atrial pressure predict improved LV reverse remodeling and survival in heart failure patients receiving cardiac resynchronization therapy?
Answers are grounded in this paper and cite their sources.
Non-invasive estimation of normal left atrial pressure before CRT is an independent predictor of LV reverse remodeling, and incorporating LA strain improves the feasibility of this estimation.
Background: We investigated the impact of baseline left atrial (LA) strain data and estimated left atrial pressure (LAP) by applying the 2016 American Society of Echocardiography and the European Association of Cardiovascular Imaging (ASE/EACVI) guidelines on cardiac resynchronization therapy (CRT) outcomes. Methods: Datasets of 219 CRT patients were retrospectively analysed. All patients had full echocardiographic diastolic function assessment before CRT and were classified based on the guideline algorithm into normal LAP (nLAP = 40%), elevated LAP (eLAP = 49%) and indeterminate LAP (iLAP = 11%). All relevant baseline characteristics were analysed. CRT-induced left ventricular (LV) reverse remodeling was measured as the relative change of LV end-systolic volume (LVESV) at 12 ± 6 months after CRT compared to baseline. Patients were followed up for all-cause mortality for a mean of 4.8 years [interquartile range (IQR): 2.7–6.0 years]. Results: At follow-up, CRT resulted in more pronounced reduction of LVESV in patients with nLAP than in patients with eLAP. In univariate analysis, nLAP was associated with LV reverse remodelling (p < 0.001), as well as long-term survival after CRT (p < 0.01). However, multivariable analysis showed that only the association between nLAP and LV reverse remodelling after CRT is independent (p < 0.01). Adding LA strain analysis to the guideline algorithm improved the feasibility of LAP estimation without affecting the association between estimated LAP and CRT outcome. Conclusion: Normal LAP before CRT, estimated using the 2016 ASE/EACVI guideline algorithm, is associated with LV reverse remodelling and long-term survival after CRT. Albeit non-independent, it can serve as a non-invasive imaging-based predictor of effective therapy. Furthermore, the inclusion of LA reservoir strain in the guideline algorithm can enhance the feasibility of LAP estimation without affecting the association between LAP and CRT outcome.
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Beela et al. (2023) conducted an observational in Heart failure (n=219). Normal estimated left atrial pressure (nLAP) vs. Elevated left atrial pressure (eLAP) was evaluated on Relative decrease in left ventricular end-systolic volume (LVESV) at 12 ± 6 months (p=<0.01). Normal estimated left atrial pressure before cardiac resynchronization therapy was associated with a significantly greater relative decrease in left ventricular end-systolic volume (47% vs 30%) compared to elevated left atrial pressure.
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