Left atrium in cardiac resynchronization therapy: Active participant or innocent bystander

Badran, Haitham; Abdelhamid, M A; Ibrahim, M T; Abdelmoteleb, A M; Zarif, John K.

doi:10.1016/j.jsha.2017.01.008

Cited by 7 publications

(8 citation statements)

References 24 publications

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“…After excluding 148 studies, 44 full articles were assessed (one from the reference list search) according to the inclusion and exclusion criteria. After careful assessment of these 44 articles, 34 were excluded and only 10 articles were includ-ed in the final analysis [22][23][24][25][26][27][28][29][30][31] (Supplementary Figure S1).…”

Section: Search Results and Trial Flowmentioning

confidence: 99%

Left atrial volume index predicts response to cardiac resynchronisation therapy: a systematic review and meta-analysis

2020

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Introduction: In responders, cardiac resynchronisation therapy (CRT) results in improved left ventricular (LV) function and reduced atrial arrhythmia. The aim of this meta-analysis was to assess the potential relationship between the left atrium (LA) volume and CRT response. Material and methods: We systematically searched all electronic databases up to August 2018 in order to select clinical trials and observational studies that assessed the predictive value of LA volume index (LAVI) of CRT response. Left ventricular end-systolic volume (LVESV) reduction ≥ 15 ml and/ or LV ejection fraction (EF) increase ≥ 10% were the documented criteria for positive CRT response. Results: A total of 2191 patients recruited in 10 studies with mean follow-up duration of 10.5 months were included in this meta-analysis. The pooled analysis showed that CRT responders had lower baseline LAVI compared to non-responders, with a weighted mean difference (WMD) of-5.89% (95% CI:-9.47 to-3.22, p < 0.001). At follow-up, LAVI fell in the CRT responders (WMD-4.36%, 95% CI:-3.54 to-5.17, p < 0.001) compared to non-responders (WMD 1.45 %, 95% CI:-0.75 to 3.65, p = 0.20). The mean change of LAVI in the CRT responders was related to the fall in LVESV, β =-1.02 (-1.46 to-0.58), p < 0.001 and the increase in LVEF, β = 2.02 (1.86 to 4.58), p = 0.001. A baseline LAVI < 34 ml/m 2 predicted CRT response with summary sensitivity 0.80% (0.53-0.95), specificity 0.74% (0.53-0.89), and odds ratio > 11. Conclusions: Baseline LAVI predicts CRT response, and its reduction reflects devise-related LA remodelling. These results emphasis the role of LAVI assessment as an integral part of cardiac function response to CRT.

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Section: Search Results and Trial Flowmentioning

confidence: 99%

Left atrial volume index predicts response to cardiac resynchronisation therapy: a systematic review and meta-analysis

2020

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“…Such a relationship is of clinical and academic interest, since the described fall in LVESV, usually referred to as a sign of LV reverse remodeling, seems to happen also in a similar way in the left atrium, with an increase in emptying fraction [20,34]. Thus, although the term reverse remodeling might sound non-specific, our results shed light on some of its ingredients in the setting of LV and LA structure and function changes in response to CRT [15][16][17][18][19][20][21]. Finally, our results highlight the fact that the LA is not only a conduit chamber but also a more complex anatomical and function structure, both in and of itself and in its relationship with the LV [35,36].…”

Section: Discussionmentioning

confidence: 66%

“…After excluding 201 studies, 20 full articles were assessed according to the inclusion and exclusion criteria. After careful assessment of these 20 articles, 13 were excluded, and only seven articles were included in the final analysis [16][17][18][19][20][21][22] (Figure S1: Supplement 2). In all LA function studies, two dimensional (2D) LA strain (PALS) was measured based on R-R gating, and the sonographers were blinded to pressure measurements.…”

Section: Search Results and Trial Flowmentioning

confidence: 99%

Improved Left Atrial Function in CRT Responders: A Systematic Review and Meta-Analysis

Bytyçi

Bajraktari

Lindqvist

et al. 2020

JCM

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Cardiac resynchronization therapy (CRT) is associated with reverse left atrial (LA) remodeling. The aim of this meta-analysis was to assess the relationship between clinical response to CRT and LA function changes. We conducted a systematic search of all electronic databases up to September 2019 which identified 488 patients from seven studies. At (mean) 6 months follow-up, LA systolic strain and emptying fraction (EF) were increased in CRT responders, with a −5.70% weighted mean difference (WMD) [95% confidence interval (CI) −8.37 to −3.04, p < 0.001 and a WMD of −8.98% [CI −15.1 to −2.84, p = 0.004], compared to non-responders. The increase in LA strain was associated with a fall in left ventricle (LV) end-systolic volume (LVESV) r = −0.56 (CI −0.68 to −0.40, p < 0.001) and an increase in the LV ejection fraction (LVEF) r = 0.58 (CI 0.42 to 0.69, p < 0.001). The increase in LA EF correlated with the fall in LVESV r = −0.51 (CI −0.63 to −0.36, p < 0.001) and the increase in the LVEF r = 0.48 (CI 0.33 to 0.61, p = 0.002). The increase in LA strain correlated with the increase in the LA EF, r = 0.57 (CI 0.43 to 0.70, p < 0.001). Thus, the improvement of LA function in CRT responders reflects LA reverse remodeling and is related to its ventricular counterpart.

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“…Moreover, the existence of prominent S-wave was associated with small left atrium in this study. Previous studies described that the left atrial area and function are associated with CRT response [ 23 , 24 ]. The reasons why S-wave amplitude was associated with left atrial diameter are unclear; however, S-wave amplitude might represent a less remodeled left atrium with remaining responsibility to CRT.…”

Section: Discussionmentioning

confidence: 99%

A Simple Predictive Marker in Cardiac Resynchronization Therapy Recipients: Prominent S-Wave in Right Precordial Leads

et al. 2021

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Background and objectives: Current guidelines criteria do not satisfactorily discriminate responders to cardiac resynchronization therapy (CRT). QRS amplitude is an established index to recognize the severity of myocardial disturbance and might be a key to optimal patient selection for CRT. Materials and Methods: (1) Initial R-wave amplitude, (2) S-wave amplitude, and (3) a summation of maximal R- or R′-wave amplitude and S-wave amplitude were measured at baseline. These parameters were averaged according to right (V1 to V3) or left (V4 to V6) precordial leads. The impact of these parameters on response to CRT, which was defined as a decrease in left ventricular end-systolic volume ≥15% at six-month follow-up, was investigated. Results: Among 47 patients (71 years old, 28 men) who received guideline-indicated CRT implantation, 25 (53%) achieved the definition of CRT responder. Among baseline electrocardiogram parameters, only the higher S-wave amplitude in right precordial leads was an independent predictor of CRT responders (odds ratio: 2.181, 95% confidence interval: 1.078–4.414, p = 0.030) at a cutoff of 1.44 mV. The cutoff was independently associated with cumulative incidence of heart failure readmission and appropriate electrical defibrillation following CRT implantation (p < 0.05, respectively). Conclusions: Prominent S-wave in right precordial leads might be a promising index to predict left ventricular reverse remodeling and greater clinical outcomes following CRT implantation.

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Left atrium in cardiac resynchronization therapy: Active participant or innocent bystander

Abstract: CRT induces LA anatomic, electrical, and structural reverse remodeling that could be assessed by conventional 2D echocardiography and 2D (ɛ) strain imaging. LA dimension and volumes were independent predictors of response to CRT and can help in selection of candidates for it.

Cited by 7 publications

References 24 publications

Left atrial volume index predicts response to cardiac resynchronisation therapy: a systematic review and meta-analysis

Left atrial volume index predicts response to cardiac resynchronisation therapy: a systematic review and meta-analysis

Improved Left Atrial Function in CRT Responders: A Systematic Review and Meta-Analysis

A Simple Predictive Marker in Cardiac Resynchronization Therapy Recipients: Prominent S-Wave in Right Precordial Leads

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