Impact of Estimated Left Atrial Pressure on Cardiac Resynchronization Therapy Outcome

Overview

Journal J Clin Med

Specialty General Medicine

Date 2023 Aug 12

PMID 37568310

Authors

Ahmed S Beela

Claudia A Manetti

Aurore Lyon

Frits W Prinzen

Tammo Delhaas

Lieven Herbots

Joost Lumens

Affiliations

Soon will be listed here.

Abstract

Background: We investigated the impact of baseline left atrial (LA) strain data and estimated left atrial pressure (LAP) by applying the 2016 American Society of Echocardiography and the European Association of Cardiovascular Imaging (ASE/EACVI) guidelines on cardiac resynchronization therapy (CRT) outcomes.

Methods: Datasets of 219 CRT patients were retrospectively analysed. All patients had full echocardiographic diastolic function assessment before CRT and were classified based on the guideline algorithm into normal LAP (nLAP = 40%), elevated LAP (eLAP = 49%) and indeterminate LAP (iLAP = 11%). All relevant baseline characteristics were analysed. CRT-induced left ventricular (LV) reverse remodeling was measured as the relative change of LV end-systolic volume (LVESV) at 12 ± 6 months after CRT compared to baseline. Patients were followed up for all-cause mortality for a mean of 4.8 years [interquartile range (IQR): 2.7-6.0 years].

Results: At follow-up, CRT resulted in more pronounced reduction of LVESV in patients with nLAP than in patients with eLAP. In univariate analysis, nLAP was associated with LV reverse remodelling ( < 0.001), as well as long-term survival after CRT ( < 0.01). However, multivariable analysis showed that only the association between nLAP and LV reverse remodelling after CRT is independent ( < 0.01). Adding LA strain analysis to the guideline algorithm improved the feasibility of LAP estimation without affecting the association between estimated LAP and CRT outcome.

Conclusion: Normal LAP before CRT, estimated using the 2016 ASE/EACVI guideline algorithm, is associated with LV reverse remodelling and long-term survival after CRT. Albeit non-independent, it can serve as a non-invasive imaging-based predictor of effective therapy. Furthermore, the inclusion of LA reservoir strain in the guideline algorithm can enhance the feasibility of LAP estimation without affecting the association between LAP and CRT outcome.

Citing Articles

Refining cardiac resynchronization therapy: a comprehensive review on the role of advanced multimodality imaging.

Stoiculescu F, Hadareanu D, Hadareanu C, Donoiu I, Florescu C Front Cardiovasc Med. 2025; 11:1406899.

PMID: 39744205 PMC: 11688290. DOI: 10.3389/fcvm.2024.1406899.

The mechanistic interaction between mechanical dyssynchrony and filling pressure in cardiac resynchronisation therapy candidates.

Beela A, Manetti C, Prinzen F, Delhaas T, Herbots L, Lumens J Eur Heart J Cardiovasc Imaging. 2024; 26(3):424-434.

PMID: 39513574 PMC: 11879185. DOI: 10.1093/ehjci/jeae286.

References

Sato K, Grant A, Negishi K, Cremer P, Negishi T, Kumar A . Reliability of updated left ventricular diastolic function recommendations in predicting elevated left ventricular filling pressure and prognosis. Am Heart J. 2017; 189:28-39. DOI: 10.1016/j.ahj.2017.03.022. View

Galli E, Smiseth MD PhD O, Aalen J, Larsen C, Sade E, Hubert A . Prognostic utility of the assessment of diastolic function in patients undergoing cardiac resynchronization therapy. Int J Cardiol. 2021; 331:144-151. DOI: 10.1016/j.ijcard.2021.01.046. View

Badano L, Kolias T, Muraru D, Abraham T, Aurigemma G, Edvardsen T . Standardization of left atrial, right ventricular, and right atrial deformation imaging using two-dimensional speckle tracking echocardiography: a consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging. 2018; 19(6):591-600. DOI: 10.1093/ehjci/jey042. View

Yu C, Zhang Q, Yip G, Chan Y, Lee P, Wu L . Are left ventricular diastolic function and diastolic asynchrony important determinants of response to cardiac resynchronization therapy?. Am J Cardiol. 2006; 98(8):1083-7. DOI: 10.1016/j.amjcard.2006.05.028. View

Stankovic I, Belmans A, Prinz C, Ciarka A, Daraban A, Kotrc M . The association of volumetric response and long-term survival after cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging. 2017; 18(10):1109-1117. DOI: 10.1093/ehjci/jex188. View

Yu C, Bleeker G, Fung J, Schalij M, Zhang Q, van der Wall E . Left ventricular reverse remodeling but not clinical improvement predicts long-term survival after cardiac resynchronization therapy. Circulation. 2005; 112(11):1580-6. DOI: 10.1161/CIRCULATIONAHA.105.538272. View

Gradaus R, Stuckenborg V, Loher A, Kobe J, Reinke F, Gunia S . Diastolic filling pattern and left ventricular diameter predict response and prognosis after cardiac resynchronisation therapy. Heart. 2007; 94(8):1026-31. DOI: 10.1136/hrt.2007.126193. View

Hansen S, Brainin P, Sengelov M, Jorgensen P, Bruun N, Olsen F . Prognostic utility of diastolic dysfunction and speckle tracking echocardiography in heart failure with reduced ejection fraction. ESC Heart Fail. 2019; 7(1):147-157. PMC: 7083408. DOI: 10.1002/ehf2.12532. View

Inoue K, Khan F, Remme E, Ohte N, Garcia-Izquierdo E, Chetrit M . Determinants of left atrial reservoir and pump strain and use of atrial strain for evaluation of left ventricular filling pressure. Eur Heart J Cardiovasc Imaging. 2021; 23(1):61-70. PMC: 8685600. DOI: 10.1093/ehjci/jeaa415. View

10.

Popescu B, Beladan C, Nagueh S, Smiseth O . How to assess left ventricular filling pressures by echocardiography in clinical practice. Eur Heart J Cardiovasc Imaging. 2022; 23(9):1127-1129. DOI: 10.1093/ehjci/jeac123. View

11.

Nagueh S, Smiseth O, Appleton C, Byrd 3rd B, Dokainish H, Edvardsen T . Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2016; 29(4):277-314. DOI: 10.1016/j.echo.2016.01.011. View

12.

Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt O . 2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy: the task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm.... Europace. 2013; 15(8):1070-118. DOI: 10.1093/europace/eut206. View

13.

Glikson M, Nielsen J, Kronborg M, Michowitz Y, Auricchio A, Barbash I . 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J. 2021; 42(35):3427-3520. DOI: 10.1093/eurheartj/ehab364. View

14.

Zoghbi W, Adams D, Bonow R, Enriquez-Sarano M, Foster E, Grayburn P . Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr. 2017; 30(4):303-371. DOI: 10.1016/j.echo.2017.01.007. View

15.

Andersen O, Smiseth O, Dokainish H, Abudiab M, Schutt R, Kumar A . Estimating Left Ventricular Filling Pressure by Echocardiography. J Am Coll Cardiol. 2017; 69(15):1937-1948. DOI: 10.1016/j.jacc.2017.01.058. View

16.

Gold M, Rickard J, Daubert J, Zimmerman P, Linde C . Redefining the Classifications of Response to Cardiac Resynchronization Therapy: Results From the REVERSE Study. JACC Clin Electrophysiol. 2021; 7(7):871-880. DOI: 10.1016/j.jacep.2020.11.010. View