Improved Left Atrial Function in CRT Responders: A Systematic Review and Meta-Analysis

Ibadete Bytyçi,Michael Y Henein,Per Lindqvist,Gani Bajraktari

doi:10.3390/jcm9020298

Abstract

Cardiac resynchronization therapy (CRT) is associated with reverse left atrial (LA) remodeling. The aim of this meta-analysis was to assess the relationship between clinical response to CRT and LA function changes. We conducted a systematic search of all electronic databases up to September 2019 which identified 488 patients from seven studies. At (mean) 6 months follow-up, LA systolic strain and emptying fraction (EF) were increased in CRT responders, with a −5.70% weighted mean difference (WMD) [95% confidence interval (CI) −8.37 to −3.04, p < 0.001 and a WMD of −8.98% [CI −15.1 to −2.84, p = 0.004], compared to non-responders. The increase in LA strain was associated with a fall in left ventricle (LV) end-systolic volume (LVESV) r = −0.56 (CI −0.68 to −0.40, p < 0.001) and an increase in the LV ejection fraction (LVEF) r = 0.58 (CI 0.42 to 0.69, p < 0.001). The increase in LA EF correlated with the fall in LVESV r = −0.51 (CI −0.63 to −0.36, p < 0.001) and the increase in the LVEF r = 0.48 (CI 0.33 to 0.61, p = 0.002). The increase in LA strain correlated with the increase in the LA EF, r = 0.57 (CI 0.43 to 0.70, p < 0.001). Thus, the improvement of LA function in CRT responders reflects LA reverse remodeling and is related to its ventricular counterpart.

Highlights

Heart failure (HF) is a clinical syndrome that is becoming a major public health problem worldwide because of its increasing incidence and prevalence as well as its related morbidity and mortality [1]
Additional searches for potential trials included the references of review articles on the subject and the abstracts presented at the scientific sessions of the European Society of Cardiology (ESC), the American Heart Association (AHA), American College of Cardiology (ACC), and European Association of Cardiovascular Imaging (EACVI)
Our analysis shows that cardiac resynchronization therapy (CRT) responders had no baseline difference in left atrium (LA) strain compared CRT non-responders, but the LA emptying fraction (EF) was higher in responders

Summary

Introduction

Heart failure (HF) is a clinical syndrome that is becoming a major public health problem worldwide because of its increasing incidence and prevalence as well as its related morbidity and mortality [1]. Responders to CRT have shown clear evidence for improved cardiac performance, left ventricular (LV) function, and the reverse remodeling of the left atrium (LA) [4,5]. The relationship between CRT-related LA and ventricular function changes remains poorly established, irrespective of the fact that CRT is associated with both cavity reverse remodeling and reduced atrial arrhythmia [6,7,8]. The aim of this meta-analysis was to assess the relationship between clinical response to CRT, LA function improvement, and LV function improvement

Methods

Results

Conclusion