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Review
. 2023 Apr 12;11(4):1156.
doi: 10.3390/biomedicines11041156.

Cardiac Resynchronization Therapy and Left Atrial Remodeling: A Novel Insight?

Andrei Dan Radu  1   2 , Alexandru Zlibut  2   3 , Alina Scarlatescu  1   2 , Cosmin Cojocaru  1   2 , Stefan Bogdan  1   4 , Alexandru Scafa-Udriște  1   2 , Maria Dorobantu  1   2
Affiliations
Review

Cardiac Resynchronization Therapy and Left Atrial Remodeling: A Novel Insight?

Andrei Dan Radu et al. Biomedicines. .

Abstract

Cardiac resynchronization therapy (CRT) restores ventricular dyssynchrony, improving left ventricle (LV) systolic function, symptoms, and outcome in patients with heart failure, systolic dysfunction, and prolonged QRS interval. The left atrium (LA) plays tremendous roles in maintaining cardiac function, being often inflicted in various cardiovascular diseases. LA remodeling implies structural-dilation, functional-altered phasic functions, and strain and electrical-atrial fibrillation remodeling. Until now, several important studies have approached the relationship between LA and CRT. LA volumes can predict responsiveness to CRT, being also associated with improved outcome in these patients. LA function and strain parameters have been shown to improve after CRT, especially in those who were positive responders to it. Further studies still need to be conducted to comprehensively characterize the impact of CRT on LA phasic function and strain, and, also, in conjunction with its impact on functional mitral regurgitation and LV diastolic dysfunction. The aim of this review was to provide an overview of current available data regarding the relation between CRT and LA remodeling.

Keywords: cardiac resynchronization therapy; left atrial phasic function; left atrial remodeling; left atrial strain; left atrial volume.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The impact of CRT on LA volumes. Patient with dilated cardiomyopathy, LVEF of 33%, and QRS morphology of LBBB with duration of 153 msec. Echocardiographic evaluation using a General Electric VIVID E95 vendor and EchoPac software package to determine LA biplane volumes (Images from the personal collection of the authors). Initial evaluation showed increased LA volumes (A) and, after a 6-month follow-up, significant LA remodeling with reduction in LA volumes can be seen (B). Abbreviations: LA, left atrium; LBBB, left bundle branch block; LVEF, left ventricle ejection fraction.
Figure 2
Figure 2
The impact of CRT on LA strain. Patient with dilated cardiomyopathy, LVEF of 33%, and QRS morphology of LBBB with duration of 153 msec. Echocardiographic evaluation using a General Electric VIVID E95 vendor and EchoPac software package to determine LA strains (Images from the personal collection of the authors). Initial evaluation showed impaired LA strains (A) and, after a 6-month follow-up, there is significant LA functional reverse remodeling with improved LA strains (B). Abbreviations: LA, left atrium; LBBB, left bundle branch block; LVEF, left ventricle ejection fraction.
See this image and copyright information in PMC

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