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Clinical implications of left atrial changes after optimization of medical therapy in patients with heart failure
AIMS: Limited data exist regarding the prognostic relevance of changes in left atrial (LA) dimensions in patients with heart failure (HF). We assessed changes in LA dimension and their relation with outcomes after optimization of guideline‐directed medical therapy (GDMT) in patients with new‐onset o...
Autores principales: | , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley & Sons, Ltd.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10084101/ https://www.ncbi.nlm.nih.gov/pubmed/35748048 http://dx.doi.org/10.1002/ejhf.2593 |
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author | Inciardi, Riccardo M. Pagnesi, Matteo Lombardi, Carlo M. Anker, Stefan D. Cleland, John G. Dickstein, Kenneth Filippatos, Gerasimos S. Lang, Chim C. Ng, Leong L. Pellicori, Pierpaolo Ponikowski, Piotr Samani, Nilesh J. Zannad, Faiez van Veldhuisen, Dirk J. Solomon, Scott D. Voors, Adriaan A. Metra, Marco |
author_facet | Inciardi, Riccardo M. Pagnesi, Matteo Lombardi, Carlo M. Anker, Stefan D. Cleland, John G. Dickstein, Kenneth Filippatos, Gerasimos S. Lang, Chim C. Ng, Leong L. Pellicori, Pierpaolo Ponikowski, Piotr Samani, Nilesh J. Zannad, Faiez van Veldhuisen, Dirk J. Solomon, Scott D. Voors, Adriaan A. Metra, Marco |
author_sort | Inciardi, Riccardo M. |
collection | PubMed |
description | AIMS: Limited data exist regarding the prognostic relevance of changes in left atrial (LA) dimensions in patients with heart failure (HF). We assessed changes in LA dimension and their relation with outcomes after optimization of guideline‐directed medical therapy (GDMT) in patients with new‐onset or worsening HF. METHODS AND RESULTS: Left atrial diameter was assessed at baseline and 9 months after GDMT optimization in 632 patients (mean age 65.8 ± 12.1 years, 22.3% female) enrolled in BIOSTAT‐CHF. LA adverse remodelling (LAAR) was defined as an increase in LA diameter on transthoracic echocardiography between baseline and 9 months. After the 9‐month visit, patients were followed for a median of 13 further months. LAAR was observed in 247 patients (39%). Larger baseline LA diameter (odds ratio [OR] 0.90; 95% confidence interval [CI] 0.87–0.93; p < 0.001) and up‐titration to higher doses of angiotensin‐converting enzyme inhibitors or angiotensin receptor blockers (ACEi/ARBs) (OR 0.56; 95% CI 0.34–0.92; p = 0.022) were independently associated with lower likelihood of LAAR. LAAR was associated with an increased risk of the composite of all‐cause mortality or HF hospitalization (log‐rank p = 0.007 and adjusted hazard ratio 1.73, 95% CI 1.22–2.45, p = 0.002). The association was more pronounced in patients without a history of atrial fibrillation (p for interaction = 0.009). CONCLUSION: Among patients enrolled in BIOSTAT‐CHF, LAAR was associated with an unfavourable outcome and was prevented by ACEi/ARB up‐titration. Changes in LA dimension may be a useful marker of response to treatment and improve risk stratification in patients with HF. |
format | Online Article Text |
id | pubmed-10084101 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | John Wiley & Sons, Ltd. |
record_format | MEDLINE/PubMed |
spelling | pubmed-100841012023-04-11 Clinical implications of left atrial changes after optimization of medical therapy in patients with heart failure Inciardi, Riccardo M. Pagnesi, Matteo Lombardi, Carlo M. Anker, Stefan D. Cleland, John G. Dickstein, Kenneth Filippatos, Gerasimos S. Lang, Chim C. Ng, Leong L. Pellicori, Pierpaolo Ponikowski, Piotr Samani, Nilesh J. Zannad, Faiez van Veldhuisen, Dirk J. Solomon, Scott D. Voors, Adriaan A. Metra, Marco Eur J Heart Fail Imaging AIMS: Limited data exist regarding the prognostic relevance of changes in left atrial (LA) dimensions in patients with heart failure (HF). We assessed changes in LA dimension and their relation with outcomes after optimization of guideline‐directed medical therapy (GDMT) in patients with new‐onset or worsening HF. METHODS AND RESULTS: Left atrial diameter was assessed at baseline and 9 months after GDMT optimization in 632 patients (mean age 65.8 ± 12.1 years, 22.3% female) enrolled in BIOSTAT‐CHF. LA adverse remodelling (LAAR) was defined as an increase in LA diameter on transthoracic echocardiography between baseline and 9 months. After the 9‐month visit, patients were followed for a median of 13 further months. LAAR was observed in 247 patients (39%). Larger baseline LA diameter (odds ratio [OR] 0.90; 95% confidence interval [CI] 0.87–0.93; p < 0.001) and up‐titration to higher doses of angiotensin‐converting enzyme inhibitors or angiotensin receptor blockers (ACEi/ARBs) (OR 0.56; 95% CI 0.34–0.92; p = 0.022) were independently associated with lower likelihood of LAAR. LAAR was associated with an increased risk of the composite of all‐cause mortality or HF hospitalization (log‐rank p = 0.007 and adjusted hazard ratio 1.73, 95% CI 1.22–2.45, p = 0.002). The association was more pronounced in patients without a history of atrial fibrillation (p for interaction = 0.009). CONCLUSION: Among patients enrolled in BIOSTAT‐CHF, LAAR was associated with an unfavourable outcome and was prevented by ACEi/ARB up‐titration. Changes in LA dimension may be a useful marker of response to treatment and improve risk stratification in patients with HF. John Wiley & Sons, Ltd. 2022-07-12 2022-11 /pmc/articles/PMC10084101/ /pubmed/35748048 http://dx.doi.org/10.1002/ejhf.2593 Text en © 2022 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Imaging Inciardi, Riccardo M. Pagnesi, Matteo Lombardi, Carlo M. Anker, Stefan D. Cleland, John G. Dickstein, Kenneth Filippatos, Gerasimos S. Lang, Chim C. Ng, Leong L. Pellicori, Pierpaolo Ponikowski, Piotr Samani, Nilesh J. Zannad, Faiez van Veldhuisen, Dirk J. Solomon, Scott D. Voors, Adriaan A. Metra, Marco Clinical implications of left atrial changes after optimization of medical therapy in patients with heart failure |
title | Clinical implications of left atrial changes after optimization of medical therapy in patients with heart failure |
title_full | Clinical implications of left atrial changes after optimization of medical therapy in patients with heart failure |
title_fullStr | Clinical implications of left atrial changes after optimization of medical therapy in patients with heart failure |
title_full_unstemmed | Clinical implications of left atrial changes after optimization of medical therapy in patients with heart failure |
title_short | Clinical implications of left atrial changes after optimization of medical therapy in patients with heart failure |
title_sort | clinical implications of left atrial changes after optimization of medical therapy in patients with heart failure |
topic | Imaging |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10084101/ https://www.ncbi.nlm.nih.gov/pubmed/35748048 http://dx.doi.org/10.1002/ejhf.2593 |
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