Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jul;18(7):e012807.
doi: 10.1161/CIRCHEARTFAILURE.125.012807. Epub 2025 May 13.

Left Atrial Reverse Remodeling in Patients Supported With Durable Left Ventricular Assist Devices and Clinical Implications

Christos P Kyriakopoulos  1   2 , Konstantinos Sideris  1 , Iosif Taleb  1   3 , Eleni Maneta  2 , Eleni Tseliou  1   2 , Jake Aadland  1 , Andrew S Baird  1 , Michael J Bonios  1   4 , Marisca Nelson  1 , Elizabeth Dranow  1 , Matthew L Goodwin  5 , Thomas C Hanff  1 , Spencer Carter  1 , Craig H Selzman  5   2 , Josef Stehlik  1 , Omar Wever-Pinzon  1 , Satvik Ramakrishna  1 , Ethan Tumarkin  1 , Stavros G Drakos  1   2
Affiliations

Left Atrial Reverse Remodeling in Patients Supported With Durable Left Ventricular Assist Devices and Clinical Implications

Christos P Kyriakopoulos et al. Circ Heart Fail. 2025 Jul.

Abstract

Background: The left atrium (LA) maintains a dynamic interaction with the left ventricle (LV). LA forward and reverse remodeling affect prognosis in patients with chronic heart failure. We examined LA reverse remodeling in patients supported with LV assist devices (LVADs) and investigated a potential impact on clinical outcomes.

Methods: Consecutive patients with advanced heart failure receiving durable, continuous-flow LVADs were prospectively evaluated (n=263). After excluding patients with unavailable echocardiographic data, 241 patients were studied. Echocardiographic assessment was performed pre- and serially post-LVAD implantation. We assessed LA and LV structure and function and their association, and the impact of LA reverse remodeling on all-cause mortality, LVAD-related adverse events, and atrial fibrillation (AF).

Results: Most patients were male, White, with a mean age of 56±15 years. Forty-four percent had underlying ischemic cardiomyopathy, and 65% were profile 1 to 3 as per the Interagency Registry for Mechanically Assisted Circulatory Support, with a mean LV ejection fraction of 19±7%, and end-diastolic diameter of 6.7±1.1 cm pre-LVAD. LA structure and function improved by 1 month on LVAD support and remained improved by 12 months, as evidenced by LA volumes, emptying volumes, emptying fractions, and strain parameters. LA changes were shown to be associated with LV structural and functional changes. The magnitude of LA reverse remodeling was associated with all-cause mortality, but not cerebrovascular accident/transient ischemic attack, LVAD thrombosis, or late right heart failure rates by 12 months on LVAD support. Of 46 patients with AF pre-LVAD, 28 (61%) converted to sinus rhythm, and 18 (39%) remained in AF during serial echocardiographic assessment.

Conclusions: LA structure and function improved early post-LVAD support, showed stability of improvement during follow-up, and were associated with simultaneous LV changes. Implications on all-cause mortality and AF might inform the care of heart failure patients being considered for advanced therapies, as well as the broader population of patients with heart failure and concomitant AF undergoing pharmacological unloading.

Keywords: atrial fibrillation; atrial remodeling; heart assist device; heart failure; prognosis.

PubMed Disclaimer

Conflict of interest statement

Dr Drakos serves as a consultant for Abbott Laboratories and Pfizer and has received research support from Novartis and Merck. The other authors report no conflicts.

References

    1. Tseliou E, Lavine KJ, Wever-Pinzon O, Topkara VK, Meyns B, Adachi I, Zimpfer D, Birks EJ, Burkhoff D, Drakos SG. Biology of myocardial recovery in advanced heart failure with long-term mechanical support. J Heart Lung Transplant. 2022;41:1309–1323. doi: 10.1016/j.healun.2022.07.007 - DOI - PubMed
    1. Kanwar MK, Selzman CH, Ton VK, Miera O, Cornwell WK 3rd, Antaki J, Drakos S, Shah P. Clinical myocardial recovery in advanced heart failure with long term left ventricular assist device support. J Heart Lung Transplant. 2022;41:1324–1334. doi: 10.1016/j.healun.2022.05.015 - DOI - PMC - PubMed
    1. Burkhoff D, Topkara VK, Sayer G, Uriel N. Reverse Remodeling With Left Ventricular Assist Devices. Circ Res. 2021;128:1594–1612. doi: 10.1161/CIRCRESAHA.121.318160 - DOI - PMC - PubMed
    1. Drakos SG, Pagani FD, Lundberg MS, Baldwin JT. Advancing the Science of Myocardial Recovery With Mechanical Circulatory Support: A Working Group of the National, Heart, Lung, and Blood Institute. JACC Basic Transl Sci. 2017;2:335–340. doi: 10.1016/j.jacbts.2016.12.003 - DOI - PMC - PubMed
    1. Drakos SG, Wever-Pinzon O, Selzman CH, Gilbert EM, Alharethi R, Reid BB, Saidi A, Diakos NA, Stoker S, Davis ES, et al. Magnitude and time course of changes induced by continuous-flow left ventricular assist device unloading in chronic heart failure: insights into cardiac recovery. J Am Coll Cardiol. 2013;61:1985–1994. doi: 10.1016/j.jacc.2013.01.072 - DOI - PMC - PubMed

MeSH terms

LinkOut - more resources