Mechanism and Impact of Left Atrial Dyssynchrony on Long-Term Clinical Outcome During Cardiac Resynchronization Therapy.

Autor:	Hammersboen LR; Institute for Surgical Research, Oslo University Hospital, Oslo, Norway; Division of Cardiovascular and Pulmonary Diseases, Cardiology Department, Oslo University Hospital. Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway., Stugaard M; Institute for Surgical Research, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Vestre Viken Hospital Trust, Ringerike, Norway., Puvrez A; University Hospitals (UZ) Leuven, Department of Cardiovascular Sciences, Leuven, Belgium., Larsen CK; Institute for Surgical Research, Oslo University Hospital, Oslo, Norway., Remme EW; Institute for Surgical Research, Oslo University Hospital, Oslo, Norway; The Intervention Center, Oslo University Hospital, Oslo, Norway., Kongsgård E; Division of Cardiovascular and Pulmonary Diseases, Cardiology Department, Oslo University Hospital. Oslo, Norway., Duchenne J; University Hospitals (UZ) Leuven, Department of Cardiovascular Sciences, Leuven, Belgium., Galli E; Laboratory Signal Processing and Image, Department of Cardiology, Rennes, France., Khan FH; Institute for Surgical Research, Oslo University Hospital, Oslo, Norway., Sletten OJ; Institute for Surgical Research, Oslo University Hospital, Oslo, Norway., Penicka M; Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium., Donal E; Laboratory Signal Processing and Image, Department of Cardiology, Rennes, France., Voigt JU; University Hospitals (UZ) Leuven, Department of Cardiovascular Sciences, Leuven, Belgium., Smiseth OA; Institute for Surgical Research, Oslo University Hospital, Oslo, Norway; Division of Cardiovascular and Pulmonary Diseases, Cardiology Department, Oslo University Hospital. Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway. Electronic address: otto.smiseth@gmail.com., Aalen JM; Institute for Surgical Research, Oslo University Hospital, Oslo, Norway; Division of Cardiovascular and Pulmonary Diseases, Cardiology Department, Oslo University Hospital. Oslo, Norway.
Jazyk:	angličtina
Zdroj:	JACC. Cardiovascular imaging [JACC Cardiovasc Imaging] 2024 Nov 11. Date of Electronic Publication: 2024 Nov 11.
DOI:	10.1016/j.jcmg.2024.09.008
Abstrakt:	Background: Left bundle branch block (LBBB) causes left atrial (LA) dyssynchrony. It is unknown if LA dyssynchrony impacts long-term prognosis. Objectives: The purpose of this study was to determine mechanisms of LA dyssynchrony in LBBB and if LA dyssynchrony impacts long-term prognosis. Methods: In a prospective multicenter study of 168 heart failure patients with LBBB, echocardiographic strain imaging was done before and after 6 months with cardiac resynchronization therapy (CRT). Outcome was assessed after 6 years. Dyssynchrony was measured relative to septum as delay in left ventricular (LV) lateral wall shortening and LA lateral wall stretch. Response to CRT was defined as at least 15% reduction in LV end-systolic volume. Results: Before CRT, there was marked LA dyssynchrony of 105 ± 76 ms, which decreased to 37 ± 68 ms in CRT-responders (P < 0.001), whereas nonresponders showed only a modest reduction in LA dyssynchrony (P < 0.05). There was strong association between LA and LV dyssynchrony (r = 0.70), consistent with direct LV-LA mechanical interaction. CRT caused modest increase in LA reservoir strain (P < 0.01) and marked increase of LV filling time (P < 0.001) in responders. Mortality after 6 years was 21% (35 deaths). LA dyssynchrony did not independently predict mortality. However, the combination of preserved LA reservoir strain (≥18%) and resolved LA dyssynchrony (≤53 ms) after 6 months with CRT was associated with excellent long term-prognosis: HR: 0.11 (95% CI: 0.03-0.42) vs preserved reservoir strain and persistent LA dyssynchrony. Conclusions: LA dyssynchrony in LBBB was attributed to direct LV-LA mechanical interactions. CRT improved diastolic function by increasing LV filling time. Patients with preserved LA reservoir strain and resolution of LA dyssynchrony by CRT had excellent long-term prognosis. (Contractile Reserve in Dyssynchrony: A Novel Principle to Identify Candidates for Cardiac Resynchronization Therapy [CRID-CRT]; NCT02525185). Competing Interests: Funding Support and Author Disclosures Dr Smiseth is co-inventor of “Method for myocardial segment work analysis,” has a patent on “Estimation of blood pressure in the heart” and has received 1 speaker honorarium from GE Healthcare. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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