Left atrial reverse remodeling improves risk stratification in patients with heart failure with recovered ejection fraction

Abstract

We aimed to investigate the relationship between left atrial (LA) reverse remodeling and prognosis of heart failure (HF) with recovered ejection fraction (EF) (HFrecEF). Among 1,246 patients with acute heart failure enrolled in the prospective longitudinal follow-up study, 397 patients with HF with mildly-reduced EF and with reduced EF at discharge were analyzed. Echocardiography was performed during the index hospitalization and at the 6-month follow-up after discharge. They were divided into non-HFrecEF (n = 227) and HFrecEF (n = 170) groups. The primary outcome measure was a composite of all-cause death or hospitalization for HF. The cumulative 180-day incidence of the primary outcome measure after follow-up echocardiography was significantly lower in the HFrecEF group than in the non-HFrecEF group (8.9% versus 23.4%, log-rank P = 0.0002). LA reverse remodeling was associated with a lower cumulative 6-month incidence of the primary outcome measure in the HFrecEF group (4.7% versus 18.0%; HR: 0.27, 95%CI: 0.09–0.79, P = 0.01), but not in the non-HFrecEF group (24.4% versus 22.6%; HR: 1.13, 95%CI: 0.65–1.96, P = 0.28) with a significant LA reverse remodeling-by-HFrecEF interaction (P for interaction = 0.02). Combination of left ventricular and atrial reverse remodeling may help in improving HF risk stratification.

Prognostic value of left atrial reverse remodelling in heart failure with preserved ejection fraction

“…26 The researchers observed that left atrial reverse remodelling was associated with a lower cumulative 6-month incidence of a composite of all-cause death or hospitalization for heart failure in patients with HFrecEF but not with non-HFrecEF, suggesting that the effect of left atrial reverse remodelling on clinical outcome was based on the recovery of LV systolic function. 26 In this study, we found that HFpEF patients with left atrial reverse remodelling had improved clinical outcomes, manifested by lower risks of hospitalization for worsening heart failure and the composite endpoint, which were consistent with previously published trials. Additionally, patients with improved left atrium did not show a statistical benefit in reducing mortality, which may be because of the relatively small sample size and lower rates of mortality observed in this study.…”

“…In a subsequent sub-study analysis, the investigators discovered that spironolactone had no significant effects on the improvement of left atrial and LV structure, whereas an overall reduction in left volume was associated with lower risks of occurrence of cardiovascular death, heart failure-related hospitalization, and aborted cardiac arrest 25 . Shiba et al conducted a prospective longitudinal study to investigate the relationship between left atrial reverse remodelling and the prognosis in heart failure with recovered ejection fraction (HFrecEF) 26 . The researchers observed that left atrial reverse remodelling was associated with a lower cumulative 6-month incidence of a composite of all-cause death or hospitalization for heart failure in patients with HFrecEF but not with non-HFrecEF, suggesting that the effect of left atrial reverse remodelling on clinical outcome was based on the recovery of LV systolic function 26 .…”

“…Shiba et al conducted a prospective longitudinal study to investigate the relationship between left atrial reverse remodelling and the prognosis in heart failure with recovered ejection fraction (HFrecEF) 26 . The researchers observed that left atrial reverse remodelling was associated with a lower cumulative 6-month incidence of a composite of all-cause death or hospitalization for heart failure in patients with HFrecEF but not with non-HFrecEF, suggesting that the effect of left atrial reverse remodelling on clinical outcome was based on the recovery of LV systolic function 26 . In this study, we found that HFpEF patients with left atrial reverse remodelling had improved clinical outcomes, manifested by lower risks of hospitalization for worsening heart failure and the composite endpoint, which were consistent with previously published trials.…”

Reverse Atrial Remodeling in Heart Failure With Recovered Ejection Fraction

“…A prospective longitudinal follow‐up study from Japan indicated that LARR was associated with a lower cumulative 6‐month incidence of composite of all‐cause death or hospitalization for HF, and the effect was based on LV reverse remodeling. 26 The multicenter automatic defibrillator implantation trial with cardiac resynchronization therapy trial demonstrated that the majority of patients with LV dysfunction and mild HF symptoms selected for cardiac resynchronization therapy–defibrillator therapy experienced a ≥20% reduction in LA volume, whereas the implanted cardiac device–only group had a significantly lower LA response at 1 year (median left atrial volume reduction: 29% [20%–36%] versus 10% [5%–14%]). 27 Consequently, patients who showed a favorable LA response to cardiac resynchronization therapy–defibrillator therapy experienced lower risks of atrial tachycardia, HF events, and death.…”