Abstract 19043: Left Atrial Structural Remodeling With Ventricular Assist Device
Introduction: Left ventricular assist devices (LVAD) have become the mainstay of therapy for patients with advanced heart failure, both as bridge to transplantation or as destination therapy. Although LVAD are associated with significant ventricular remodeling, its impact on left atrial (LA) remodeling is not known.
Hypothesis: LVAD may have a significant impact on atrial remodeling through alteration in atrial filling pressures and perfusion.
Methods: All patients who underwent LVAD implantation from 2008 to 2015 were included. Medical records and electrocardiograms were abstracted to determine baseline characteristics and arrhythmia incidence. Echocardiograms before and after the LVAD implantation were reviewed for LA size and volume. LA sizes were graded from 0 to 3 (0=normal, 1=mildly enlarged, 2=moderately enlarged and 3=severely enlarged).
Results: A total of 331 consecutive patients were followed for a median of 331 days. Mean age was 57.8±12.8 years, 256 (77.3%) were male, mean left ventricular ejection fraction was 20±6.6%, 124 (37.5%) had ischemic cardiomyopathy and 184 (58%) were implanted as destination therapy. LA descriptions were available for 314 (98%) patients prior to LVAD and 170 (51.4%) patients after LVAD. Follow up echocardiogram was completed at a median of 290 days of follow up. At baseline mean LA size was 2.6±0.04 (between moderate and severely dilated) and mean LA volume index was 56.8±22.0 ml/m2. This improved significantly to 2.0±0.1 (moderately dilated) and 46.8±15.0 ml/m2 at follow up (p<0.005). LA volume index and LA size descriptions from patients followed for less than 1 year was not significantly different from patients followed for greater than 1 year. This change in LA geometry was also consistent when only patients with echocardiogram data before and after LVAD placement were considered. In patients with persistent atrial fibrillation, LA geometry at baseline and follow up remained constantly abnormal with no significant difference.
Conclusions: LVAD is associated with significant LA structural remodeling. LA size and volume may be an important marker for inadequate mechanical unloading and a possible non-invasive parameter for the chronic optimization of LVAD.
Author Disclosures: A. Deshmukh: None. E. Anyanwu: None. N. Uriel: Research Grant; Significant; Heartware, Thoratec, Caredx, Medtronic. Consultant/Advisory Board; Modest; Thoratec, Heartware, Abiomed, Medtronic. V. Jeevanandam: None. R. Tung: None. C. Ozcan: None.
- © 2016 by American Heart Association, Inc.