Left Atrial Reverse Remodeling and Cardiac Resynchronization Therapy for Chronic Heart Failure Patients in Sinus Rhythm

Background Cardiac resynchronization therapy (CRT), which improves left ventricular (LV) function and reverses LV remodeling, is an established therapy for advanced heart failure with prolonged QRS duration. The aim of this study was to examine whether CRT improves atrial function and induces atrial reverse remodeling. Methods A total of 46 patients with heart failure (mean age, 66.7 ± 10.4 years) who underwent CRT were evaluated with echocardiography before and after 6 months of optimized CRT. Atrial function and LV function were assessed with M-mode, two-dimensional echocardiography, Doppler, tissue Doppler velocity, and strain (ϵ) imaging. LV reverse remodeling was defined as a reduction in LV end-systolic volume of >15%. Results In responders (n = 23), significant improvements in left atrial (LA) functional, structural, and anatomic remodeling were observed. Maximum LA area and volume decreased, the LA emptying fraction increased, A′ increased, and LA ϵ increased from 25.6 ± 11.0% to 42.6 ± 10.4% ( P < .05 overall). LA reverse remodeling was correlated with baseline LA volume ( R = 0.45). Although the correlation was not significant ( r = 0.24), LA reverse remodeling was also more frequent in patients with LV reverse remodeling. Conclusions In patients with LV remodeling, significant LA reverse remodeling after CRT could be observed and detailed on transthoracic echocardiography.