Left atrial remodeling and recurrence of congestive heart failure

Abstract

Background: It has been suggested that left atrial volumes (LAV) represent long-term exposure to elevated pressures. The objectives of this study were to determine the recurrence of heart failure based on LAV in patients originally diagnosed congestive heart failure (CHF). Methods and results: This study comprised 77 patients (75±8 years) with well-documented, clinically defined heart failure and complete two-dimensional echocardiographic examinations. The echocardiographic examinations were performed on admission and after medical treatment (60±43 days after initial study). Patients with atrial fibrillation, flail mitral valve or mitral valve replacement were excluded from this study. The initial left ventricular ejection fraction (LVEF) was 44±17% and indexed LAV was 61±22 ml/m2. A decrease in indexed LAV was observed in 38 patients and an increase in indexed LAV (LA remodeling) was observed in the remaining 39 patients after medical treatment. With mean follow-up periods of 424 days, patients with LA remodeling had a significantly higher incidence of recurrence of CHF compared to patients with decreased indexed LAV (p=0.008). Their event (recurrence of CHF)-free survival rate was 36±13% vs. 81±9%. In a multivariate analysis, follow-up LV end-systolic volume (p=0.04), LVEF (p=0.005) and indexed LAV (p=0.04) independently predicted recurrence of CHF, compared with clinical and other echocardiographic variables. Conclusion: Patients originally diagnosed with CHF follow divergent courses based on LAV. LA remodeling after medical treatment can be useful for predicting recurrence of CHF during follow-up.