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. 2024 Dec;11(6):4285-4295.
doi: 10.1002/ehf2.15023. Epub 2024 Aug 26.

Prognostic value of left atrial reverse remodelling in patients hospitalized with acute decompensated heart failure

Sakura Nagumo  1 , Mio Ebato  1 , Miki Tsujiuchi  1 , Takuya Mizukami  2 , Hideyuki Maezawa  1 , Ayumi Omura  1 , Megumi Kubota  1 , Maho Ohmi  1 , Yuki Numajiri  1 , Hitomi Kitai  3   4 , Tsutomu Toshida  1 , Yoshitaka Iso  1 , Hiroshi Suzuki  1
Affiliations

Prognostic value of left atrial reverse remodelling in patients hospitalized with acute decompensated heart failure

Sakura Nagumo et al. ESC Heart Fail. 2024 Dec.

Abstract

Aims: Left atrial (LA) volume index (LAVI) in chronic heart failure (HF) predicts cardiovascular outcomes. However, the association between LAVI reduction during acute decompensated HF (ADHF) and its prognostic potential is limited. We hypothesized that LA reverse remodelling (LARR) after ADHF therapy would be associated with better clinical outcomes.

Methods: This retrospective study analysed clinical outcomes and the LAVI reduction rate of 363 out of 861 patients hospitalized for ADHF who underwent two-point echocardiography at admission and discharge between January 2015 and December 2019. The mean age was 74.3 ± 13.6 years, and the mean ejection fraction (EF) was 38.9 ± 15.2%. The follow-up echocardiogram was performed 13.0 [9.5, 20] days after admission. As the median LAVI reduction rate was 7.02%, the LARR was defined as an LAVI reduction rate >7%.

Results: During the 34.0 ± 20.2 months of follow-up, 117 patients (32.2%) reached the primary endpoint defined as cardiovascular death and rehospitalization for ADHF. Kaplan-Meier survival analysis showed that patients with LARR had a better prognosis. Multivariate analysis indicated that LARR was an independent predictor of cardiovascular events. Similar findings were observed in the subgroup analyses of patients with persistent/permanent atrial fibrillation and those with non-HF with reduced EF. Among patients who were brain natriuretic peptide (BNP) responders, defined as a relative reduction of >70% in BNP from admission to discharge, non-LARR was observed in 41.6%. BNP responders without LARR experienced worse prognoses.

Conclusions: LARR in the early vulnerable phase after hospitalization for ADHF was associated with better long-term clinical outcomes.

Keywords: LA reverse remodelling; LAVI; acute decompensated heart failure.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
Study flowchart. A total of 861 patients were screened, and 363 were included in this study. ADHF, acute decompensated heart failure; LAVI, left atrial volume index.
Figure 2
Figure 2
Freedom for cardiovascular death or rehospitalization for acute decompensated heart failure. The Kaplan–Meier curve indicates a significantly lower event rate of the composite endpoints in patients with left atrial reverse remodelling (LARR).
Figure 3
Figure 3
Freedom for cardiovascular death or rehospitalization for acute heart failure in patients with persistent/permanent atrial fibrillation. Left atrial reverse remodelling (LARR) indicated a significantly lower event rate of the composite endpoint in patients with persistent/permanent atrial fibrillation.
Figure 4
Figure 4
Freedom for cardiovascular death or rehospitalization for acute heart failure in patients with (A) HF with reduced ejection fraction (HFrEF) and (B) non‐HFrEF. The Kaplan–Meier curve indicated a significantly lower event rate of the composite endpoint in patients with left atrial reverse remodelling (LARR) in both (A) the HFrEF and (B) non‐HFrEF groups.
See this image and copyright information in PMC

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