Left atrial strain is a predictor of left ventricular systolic and diastolic reverse remodelling in CRT candidates

Elena Galli (1, 2) , Emmanuel Oger (3, 2) , John M Aalen (4, 5) , Jürgen Duchenne (6) , Camilla K Larsen (4) , Elif Sade (7, 8) , Arnaud Hubert (1, 2) , Alban Gallard (1, 2) , Martin Penicka (9) , Cecilia Linde (10) , Virginie Le Rolle (1, 2) , Alfredo Hernandez (1, 2) , Christophe Leclercq (1, 2) , Jens-Uwe Voigt (6) , Otto A Smiseth (4) , Erwan Donal (1, 2)

1 LTSI - Laboratoire Traitement du Signal et de l'Image
2 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
3 REPERES - Recherche en Pharmaco-épidémiologie et Recours aux Soins
4 UiO - University of Oslo
5 Oslo University Hospital [Oslo]
6 KU Leuven - Catholic University of Leuven = Katholieke Universiteit Leuven
7 Başkent University Hospital [Adana, Turkey]
8 PITT - University of Pittsburgh
9 OLV Ziekenhuis [Aslst]
10 Karolinska Institutet [Stockholm]

AIMS: The left atrium (LA) has a pivotal role in cardiac performance and LA deformation is a well-known prognostic predictor in several clinical conditions including heart failure with reduced ejection fraction. The aim of this study is to investigate the effect of cardiac resynchronization therapy (CRT) on both LA morphology and function and to assess the impact of LA reservoir strain (LARS) on left ventricular (LV) systolic and diastolic remodelling after CRT. METHODS AND RESULTS: Two hundred and twenty-one CRT-candidates were prospectively included in the study in four tertiary centres and underwent echocardiography before CRT-implantation and at 6-month follow-up (FU). CRT-response was defined by a 15% reduction in LV end-systolic volume. LV systolic and diastolic remodelling were defined as the percent reduction in LV end-systolic and end-diastolic volume at FU. Indexed LA volume (LAVI) and LV-global longitudinal (GLS) strain were the main parameters correlated with LARS, with LV-GLS being the strongest determinant of LARS (r = -0.59, P < 0.0001). CRT induced a significant improvement in LAVI and LARS in responders (both P < 0.0001). LARS was an independent predictor of both LV systolic and diastolic remodelling at follow-up (r = -0.14, P = 0.049 and r = -0.17, P = 0.002, respectively). CONCLUSION: CRT induces a significant improvement in LAVI and LARS in responders. In CRT candidates, the evaluation of LARS before CRT delivery is an independent predictor of LV systolic and diastolic remodelling at FU.

Mots clés: cardiac resynchronization therapy; heart failure; left atrial strain

Domaines: Ingénierie biomédicale

Elena Galli, Emmanuel Oger, John M Aalen, Jürgen Duchenne, Camilla K Larsen, et al.. Left atrial strain is a predictor of left ventricular systolic and diastolic reverse remodelling in CRT candidates. European Heart Journal - Cardiovascular Imaging, 2022, 23 (10), pp.1373-1382. ⟨10.1093/ehjci/jeab163⟩. ⟨hal-03332069⟩