Author + information
Left atrial volume (LAV) is a reliable predictor of outcomes in congestive heart failure (CHF). We evaluated the relation between LAV and clinical outcomes in mildly symptomatic HF patients randomized to cardiac resynchronization therapy with a defibrillator (CRT-D) or defibrillator (ICD)- only in MADIT-CRT
The benefit of CRT-D vs. ICD-only in reducing the risk of HF or death was assessed by LAV index ([LAVi] dichotomized at the upper quartile of >52 ml/m2 among 1,785 patients enrolled in MADIT-CRT. Landmark analysis was employed to evaluate the relation between LAVi response to CRT-D and subsequent clinical outcomes.
Multivariate analysis showed that patients with high LAVi (>52 ml/m2) had a 63% increase in the risk for HF or death (p<0.01) and a 59% (p=0.02) increase in the risk of death as compared with patients with lower LAVi. CRT-D similarly benefitted patients with both high and low LAVi, and induced a significant reductions in LAVi compared with ICD-only (−28% and −10%, respectively; p<0.001). Landmark analysis showed that LAV responders to CRT-D (>25% reductions in LAVi at 1-year) had a significant lower risk of subsequent HF or death compared with both ICD-only patients and LAV non-responders to the device (Figure), independent of the CRT-D induced changes on LVESV.
LAV is an independent predictor of prognosis in patients with mild HF treated with CRT-D. CRT-D exerts pronounced reverse remodeling effects on the LA that are associated with improved outcome.
Oral Contributions West, Room 2006
Saturday, March 09, 2013, 9:00 a.m.-9:15 a.m.
Session Title: Resynchronization Therapy and Right Ventricular Function
Abstract Category: 17. Heart Failure: Therapy
Presentation Number: 906-7
- 2013 American College of Cardiology Foundation