Abstract 19893: Concordant and Discordant Atrial and Ventricular Remodeling in Patients with Cardiac Resynchronization Therapy
Introduction: We explored the effect of simultaneous atrial and ventricular remodeling on cardiovascular mortality or hospitalizations during cardiac resynchronization therapy (CRT) in patients with atrial fibrillation (AF) or sinus rhythm (SR).
Methods: We included 388 CRT patients. Patients were categorized into four groups based on ventricular and atrial response. Ventricular response was defined as a reduction in left ventricular end systolic volume (LVESV) of ≥15% at 6-month follow-up. Atrial response was defined as a decrease in left atrial volume index (LAVI) at 6-month follow-up. Patients had either concordant remodeling (ventricular response, LAVI decrease), concordant non-remodeling (no ventricular response, LAVI increase) or discordant remodeling (ventricular response and LAVI increase or vice-versa).
Results: Of 388 patients, 282 (73%) were male, 186 (48%) had hypertension, and 183 (47%) ischemic cardiomyopathy. At baseline 152 (39%) had a history of AF. During a median follow up of two years, 36 (9%) developed new-onset AF, and 200 (52%) patients had continuous SR. There were no differences in baseline characteristics between the four groups. Patients with concordant remodeling at six months had larger LVESV (191 versus 147 ml, p=0.001) at baseline compared to concordant non-remodeling patients. LAVI (46 versus 41 ml/m2, p=0.283) was equal. Ventricular response was equal in AF versus new-onset AF versus SR patients (57% versus 53% versus 54%, p=0.85). Concordant non-remodeling patients have the worst outcome (figure). Cox regression analysis revealed that concordant non-remodeling was associated with cardiovascular mortality or hospitalization, after adjustment for sex, age, hypertension, ICM, and AF (hazard ratio 2.99, 95% confidence interval 1.35-6.65, p=0.007).
Conclusion: Concordant non-remodeling (no ventricular response and LAVI increase) appears to have the worst prognosis, irrespective of underlying heart rhythm.
Author Disclosures: M. Kloosterman: None. M. Rienstra: None. B.A. Mulder: None. A.H. Maass: None. I.C. Van Gelder: None.
- © 2014 by American Heart Association, Inc.