Abstract 15057: Left Atrial Reverse Remodeling and Outcome in Patients with Heart Failure
Background: It has been suggested that left atrial volumes (LAV) represent long-term exposure to elevated pressures. The Objectives of this study were to determine the outcome and the predictors of adverse events based on LAV in patients originally diagnosed congestive heart failure.
Methods and Results: This study comprised 70 patients (71±10 years) with well-documented, clinically defined heart failure and a complete two-dimensional echocardiographic examination. The echocardiographic examinations were performed on admission and after medical treatment (90±81 days after initial study) . Patients with atrial fibrillation, flail mitral valve or mitral valve replacement were excluded from this study. The initial left ventricular ejection fraction (LVEF) was 57±16% and indexed LAV was 58±20 mL/m2. A decrease in indexed LAV was observed in 29 patients and an increase in indexed LAV was observed in the remaining 41 patients after medical treatment. With mean follow-up periods of 436 days, patients with LA reverse remodeling had a significantly lower incidence of cardiac events (cardiac death, recurrence of congestive heart failure and angina pectoris) compared to patients with increased indexed LAV (p=0.005, HR: 13.991, 95%CI: 2.181–89.747). Their event-free survival rate was 64±15% versus 35±12% (p= 0.02). In a multivariable analysis, follow-up LV end-diastolic volume (p = 0.013), LV end-systolic volume (p=0.015), LVEF (p=0.019) and indexed LAV (p=0.004) independently predeicted cardiac events, compared with clinical and echocardiographic variables. Patients with indexed LAV =53 mL/m2 after medical treatment had a significantly worse event-free survival (p=0.02).
Conclusion: Patients originally diagnosed with congestive heart failure follow divergent courses based on LAV. Patients with increased LAV after medical treatment experienced adverse cardiac events during follow-up.
- © 2010 by American Heart Association, Inc.