Kloosterman, M. (Marielle) (2015) Simultaneous Atrial and Ventricular (Reverse) Remodeling in Patients receiving Cardiac Resynchronization Therapy. thesis, Medicine.
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Abstract
Cardiac resynchronization therapy (CRT) is an effective treatment for selected patients with advanced heart failure and cardiac dyssynchrony, leading to ventricular reverse remodeling in 50-60% of patients. However, the simultaneous effect of CRT on left atrial (LA) volume is unknown. This study explored the prognostic implications of changes in left atrial volume in combination with ventricular reverse remodeling in patients with either sinus rhythm (SR) or atrial fibrillation (AF). Consecutive patients receiving a CRT device in the University Medical Centre Groningen, with available echocardiographic images, were included in the current analysis. Atrial reverse remodeling was defined as a reduction of left atrial volume index (LAVI) of ≥10% after six months. Ventricular reverse remodeling was defined as a reduction of left ventricular end systolic volume of ≥15% after six months. 365 patients (mean age 65.1±11.0 years, 73% men) met all study criteria. 221 patients (61%) were in sinus rhythm and had no prior history of AF, 144 patients (39%) had a history of AF. Patients without atrial reverse remodeling had more often a history of AF (110 [44%] versus 34 [29%], p=0.007). Patients without ventricular reverse remodeling had a larger left atrial size at baseline (64±10 mm versus 67±10 mm, p=0.009). During a mean follow up of 2.0±1.0 years a total of 53 patients died. Cox regression analysis revealed that only patients without atrial- and ventricular reverse remodeling had a significantly worse outcome (hazard ratio 3.1, 95% confidence interval 1.4-7.1, p=0.006). Atrial reverse remodeling in the absence of ventricular reverse remodeling was associated with an intermediate outcome (hazard ratio 2.0, 95% confidence interval 0.7-5.6, p=0.2). Atrial reverse remodeling seems to be an important contributor. Including atrial reverse remodeling in analyses may provide additional prognostic information in determining CRT outcome.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Faculty supervisor: and Gelder, Prof. dr. Isabelle C. van and Second supervisor: and Maass, dr. Alexander H. and University Medical Center Groningen – Cardiology Department |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:50 |
| Last Modified: | 25 Jun 2020 10:50 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1112 |
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