Clinical implications of left atrial reverse remodelling after cardiac resynchronization therapy

Figures

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  Figure 1. Left atrial speckle tracking strain analysis. LA speckle tracking strain analysis in CRT recipients was performed in an apical four-chamber view. Regional strain vs. time curves are represented by coloured lines, while the average LA strain vs. time curve is represented by the dotted line. LARS is indicated by the arrow. (A) Shows the LA strain before CRT implantation (LARS 15%), whereas (B) shows the LA strain after CRT implantation (LARS 27%). CRT, cardiac resynchronization therapy; LA, left atrial; LARS, left atrial reservoir strain.

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  Figure 2. Spline curve for all-cause mortality according to change in LV GLS (A) and LARS (B). The curves represent the hazard ratio for all-cause mortality with overlaid 95% confidence intervals across the range of percentage change in LV GLS (A) and LARS (B) at 6 months after CRT implantation, compared with pre-implantation values. CRT, cardiac resynchronization therapy; LARS, left atrial reservoir strain; LV GLS, left ventricular global longitudinal strain.

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  Figure 3. Kaplan–Meier curve for time to cumulative survival, according to the three different study groups. LA, left atrium; LARS, left atrial reservoir strain; LV, left ventricle; LV GLS, left ventricular global longitudinal strain.

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  Figure 4. Likelihood ratio test for the incremental prognostic value of a significant change in LV GLS and LARS. The addition of a 20% change in LV GLS and a 5% change in LARS to a baseline clinical model is associated with significant increases in the χ2 value. *The baseline model includes age, sex, arterial hypertension, diabetes mellitus, dyslipidaemia, ischaemic aetiology for heart failure, estimated glomerular filtration rate, New York Heart Association functional class III–IV, baseline left ventricular end-systolic volume, baseline left atrium volume index, baseline left atrial reservoir strain, baseline left ventricular global longitudinal strain, and tricuspid annular plane systolic excursion. LARS, left atrial reservoir strain; LV ESV, left ventricular end-systolic volume; LV GLS, left ventricular global longitudinal strain.