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CLINICAL RESEARCH: HEART FAILURE

Improvement of Atrial Function and Atrial Reverse Remodeling After Cardiac Resynchronization Therapy for Heart Failure

Cheuk-Man Yu, MD, FRCP, FRACP^_*,_*, Fang Fang, MM, PhD, Qing Zhang, MM, PhD^_*, Gabriel W.K. Yip, MD^_*, Chun Mei Li, BM^_*, Joseph Yat-Sun Chan, FHKAM^_*, LiWen Wu, BM^_* and Jeffrey Wing-Hong Fung, FRCP^_*

^_* Li Ka Shing Institute of Health Sciences, Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital and Institute of Vascular Medicine, S.H. Ho Cardiovascular and Stroke Centre, Shatin, N.T., Hong Kong, China
Ultrasound Department, Beijing AnZhen Hospital, Capital Medical University, Beijing, China.

Manuscript received December 22, 2006; revised manuscript received April 10, 2007, accepted April 16, 2007.

^_* Reprint requests and correspondence: Prof. Cheuk-Man Yu, Li Ka Shing Institute of Health Sciences, Institute of Vascular Medicine, S. H. Ho Cardiovascular and Stroke Centre, Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong. (Email: cmyu{at}cuhk.edu.hk).

Objectives: We sought to examine whether cardiac resynchronization therapy (CRT) improves atrial function and induces atrial reverse remodeling.

Background: Cardiac resynchronization therapy is an established therapy for advanced heart failure with prolonged QRS duration, which improves left ventricle (LV) function and is associated with LV reverse remodeling.

Methods: A total of 107 heart failure patients (66 ± 11 years) who received CRT and were followed up for 3 months were studied. Atrial function was assessed by M-mode, 2-dimensional echocardiography, transmitral Doppler, tissue Doppler velocity, and strain () imaging. Left atrial (LA) emptying fraction based on the change in areas (LAA-EF) and volumes (LAV-EF) were calculated. The LV reverse remodeling was defined by a reduction of LV end-systolic volume >10%.

Results: In the responders of LV reverse remodeling (n = 62), LAA-EF and LAV-EF were significantly increased (p < 0.001). Responders also had significant decrease in LA size area and volumetric measurements, both before (p < 0.05) and after atrial systole (p < 0.001). However, these parameters were unchanged in the nonresponders (n = 45, p = NS). In the responders, tissue Doppler velocity analysis showed improvement of contraction velocity in both left (p = 0.005) and right atria (p = 0.018), whereas in both atria were increased in all the phases of cardiac cycle, namely ventricular end-systole (p < 0.001), early diastole (p < 0.001), and late diastole (p = 0.007).

Conclusions: Cardiac resynchronization therapy improves both left and right atrial pump function. The increase in atrial throughout the cardiac cycle is likely reflecting the improvement of atrial compliance. These changes lead to LA reverse remodeling with reduction of LA size before and after atrial systole.

Abbreviations and Acronyms    = strain   3ch = 3-chamber   4ch = 4-chamber   CRT = cardiac resynchronization therapy   IAS = interatrial septum   LA = left atrial   LAA-EF = left atrial emptying fraction based on the change in areas   LAV-EF = left atrial emptying fraction based on the change in volumes   LV = left ventricular   NYHA = New York Heart Association   RA = right atrial

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