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Impact of Estimated Left Atrial Pressure on Cardiac Resynchronization Therapy Outcome

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)...

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Detalles Bibliográficos
Autores principales: Beela, Ahmed S., Manetti, Claudia A., Lyon, Aurore, Prinzen, Frits W., Delhaas, Tammo, Herbots, Lieven, Lumens, Joost
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10419616/
https://www.ncbi.nlm.nih.gov/pubmed/37568310
http://dx.doi.org/10.3390/jcm12154908
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author Beela, Ahmed S.
Manetti, Claudia A.
Lyon, Aurore
Prinzen, Frits W.
Delhaas, Tammo
Herbots, Lieven
Lumens, Joost
author_facet Beela, Ahmed S.
Manetti, Claudia A.
Lyon, Aurore
Prinzen, Frits W.
Delhaas, Tammo
Herbots, Lieven
Lumens, Joost
author_sort Beela, Ahmed S.
collection PubMed
description 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 (p < 0.001), as well as long-term survival after CRT (p < 0.01). However, multivariable analysis showed that only the association between nLAP and LV reverse remodelling after CRT is independent (p < 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.
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spelling pubmed-104196162023-08-12 Impact of Estimated Left Atrial Pressure on Cardiac Resynchronization Therapy Outcome Beela, Ahmed S. Manetti, Claudia A. Lyon, Aurore Prinzen, Frits W. Delhaas, Tammo Herbots, Lieven Lumens, Joost J Clin Med Article 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 (p < 0.001), as well as long-term survival after CRT (p < 0.01). However, multivariable analysis showed that only the association between nLAP and LV reverse remodelling after CRT is independent (p < 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. MDPI 2023-07-26 /pmc/articles/PMC10419616/ /pubmed/37568310 http://dx.doi.org/10.3390/jcm12154908 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Beela, Ahmed S.
Manetti, Claudia A.
Lyon, Aurore
Prinzen, Frits W.
Delhaas, Tammo
Herbots, Lieven
Lumens, Joost
Impact of Estimated Left Atrial Pressure on Cardiac Resynchronization Therapy Outcome
title Impact of Estimated Left Atrial Pressure on Cardiac Resynchronization Therapy Outcome
title_full Impact of Estimated Left Atrial Pressure on Cardiac Resynchronization Therapy Outcome
title_fullStr Impact of Estimated Left Atrial Pressure on Cardiac Resynchronization Therapy Outcome
title_full_unstemmed Impact of Estimated Left Atrial Pressure on Cardiac Resynchronization Therapy Outcome
title_short Impact of Estimated Left Atrial Pressure on Cardiac Resynchronization Therapy Outcome
title_sort impact of estimated left atrial pressure on cardiac resynchronization therapy outcome
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10419616/
https://www.ncbi.nlm.nih.gov/pubmed/37568310
http://dx.doi.org/10.3390/jcm12154908
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