Left atrial functional reverse remodeling assessed by speckle tracking echocardiography in a real-life population of patients with chronic heart failure after therapy with sacubitril/valsartan

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Left atrial (LA) enlargement has been demonstrated to be a predictor of adverse cardiovascular outcomes, such as atrial fibrillation (AF), heart failure (HF), and cardiovascular death (1). Previous studies showed left atrial structural reverse remodeling (LARR), defined as >15% reduction in LA end-systolic volume index (LAESVi) (2), can be achieved after therapy with Sacubitril/Valsartan (S/V) in real-world settings. On the other hand, LA functional reverse remodeling is not well defined. Purpose We sought to investigate the association between left atrial (LA) structural and functional remodelling in patients with chronic heart failure after therapy with S/V. Methods Patients with chronic HF, LV dysfunction (EF < 35%), NYHA class II-III were followed up between September 2019 and March 2020. All patients underwent clinical and echocardiography follow up at baseline and after 6 months of therapy with S/V. Measures of LA structure [LA end-systolic volume index (LAESVi)] and function [left atrial ejection fraction (LAEF), peak atrial longitudinal strain (PALS), LA conduit strain, and peak atrial contraction strain (PACS)] were calculated. We divided our population into two subgroups based on whether reverse remodeling was achieved (LARR+) or not (LARR-). Results Forty-seven consecutive outpatients (mean age 66 ± 8 years; 85% males) were enrolled in the study. At follow-up visit, a positive LARR was found in nearly half of patients treated with S/V, resulting in line with previous studies (3). Furthermore, global PALS was significantly improved in both groups compared to baseline (15 ± 7 vs 19 ± 8 %, p < 0.001), but the LARR+ group showed an improvement that was twice higher (55 ± 66 vs 25 ± 26, p = 0.039), supporting the potential role of PALS as marker of functional LARR. Conclusions Treatment with S/V in patients with systolic dysfunction is associated with an improvement in LA structural and functional remodelling in a real-world scenario. Therefore, PALS could be the benchmark for the assessment of left atrial functional reverse remodeling.