Left atrial strain is a predictor of left ventricular systolic and diastolic reverse remodelling in CRT candidates

Eur Heart J Cardiovasc Imaging. 2022 Sep 10;23(10):1373-1382. doi: 10.1093/ehjci/jeab163.


Aims: The left atrium (LA) has a pivotal role in cardiac performance and LA deformation is a well-known prognostic predictor in several clinical conditions including heart failure with reduced ejection fraction. The aim of this study is to investigate the effect of cardiac resynchronization therapy (CRT) on both LA morphology and function and to assess the impact of LA reservoir strain (LARS) on left ventricular (LV) systolic and diastolic remodelling after CRT.

Methods and results: Two hundred and twenty-one CRT-candidates were prospectively included in the study in four tertiary centres and underwent echocardiography before CRT-implantation and at 6-month follow-up (FU). CRT-response was defined by a 15% reduction in LV end-systolic volume. LV systolic and diastolic remodelling were defined as the percent reduction in LV end-systolic and end-diastolic volume at FU. Indexed LA volume (LAVI) and LV-global longitudinal (GLS) strain were the main parameters correlated with LARS, with LV-GLS being the strongest determinant of LARS (r = -0.59, P < 0.0001). CRT induced a significant improvement in LAVI and LARS in responders (both P < 0.0001). LARS was an independent predictor of both LV systolic and diastolic remodelling at follow-up (r = -0.14, P = 0.049 and r = -0.17, P = 0.002, respectively).

Conclusion: CRT induces a significant improvement in LAVI and LARS in responders. In CRT candidates, the evaluation of LARS before CRT delivery is an independent predictor of LV systolic and diastolic remodelling at FU.

Keywords: cardiac resynchronization therapy; heart failure; left atrial strain.

MeSH terms

  • Cardiac Resynchronization Therapy* / methods
  • Diastole
  • Echocardiography / methods
  • Heart Atria / diagnostic imaging
  • Heart Failure* / diagnostic imaging
  • Heart Failure* / therapy
  • Heart Murmurs
  • Heart Ventricles / diagnostic imaging
  • Humans
  • Treatment Outcome
  • Ventricular Dysfunction, Left* / diagnostic imaging
  • Ventricular Dysfunction, Left* / therapy