Magnitude and Time Course of Left Atrial Remodeling Changes in Patients Undergoing Chronic Left Ventricular Assist Device Support

Abstract

Although left ventricular (LV) reverse remodeling has been described in patients with left ventricular assist devices (LVADs), little is known about left atrial (LA) structural and functional changes. Echocardiographic parameters were obtained at pre-LVAD implant and following 1, 3, and 6 months of LVAD support. Favorable LV structural and functional response following LVAD support (i.e. Responders) was defined using previously published criteria. Structural and functional indices specific to LA such as LA volume index (LAVI) and LA total emptying fraction (LATEF) were compared in eighteen Responders versus twenty Non-Responders. Statistical comparison of quantitative data was performed using 2-tailed Wilcoxon signed-rank test for paired samples and categorical data were compared using Fisher's exact test. The magnitude and time course of functional changes as reflected by the LVEF and LATEF in Responders and Non-Responders are depicted in Figure 1A and 1B. LA remodeling structural changes over time in Responders and Non-Responders are depicted in Figure 1C. Patients experiencing post-LVAD favorable LV functional response had significantly better LA remodeling structural and functional indices before LVAD implantation and further improved those early after the initiation of LV mechanical support. LA reverse remodeling studies with longer follow-up and correlation with post LVAD-weaning patient outcomes are warranted.