Left Atrial Reverse Remodeling in Dilated Cardiomyopathy

Background: Left atrial (LA) dilation is associated with a worse prognosis in several cardiovascular settings, but therapies can promote LA reverse remodeling. The aim of this study was to characterize and define the prognostic implications of LA volume index (LAVI) reduction in patients with dilated cardiomyopathy (DCM).Methods: Consecutive patients with DCM from two tertiary care centers, with available echocardiograms at baseline and at 1-year follow-up, were retrospectively analyzed. LA dilation was defined as LAVI > 34 mL/m2, and change in LAVI (ALAVI) was defined as the 1-year relative LAVI reduction. The outcome was a composite of death, heart transplantation (HTx), or heart failure hospitalization (HFH).Results: Five hundred sixty patients were included (mean age, 54 & PLUSMN; 13 years; mean left ventricular ejection frac-tion, 31 & PLUSMN; 10%; mean LAVI, 45 & PLUSMN; 18 mL/m2). Baseline LAVI had a non-linear association with the risk for death, HTx, or HFH, independent of age, left ventricular ejection fraction, mitral regurgitation, and medical therapy (P < .01). At 1-year follow-up, LAVI decreased in 374 patients (67%; median ALAVI, -24%; interquartile range, -37% to -11%). Factors independently associated with ALAVI were higher baseline LAVI and lower baseline left ventricular ejection fraction. After multivariable adjustment, ALAVI showed a linear association with the risk for death, HTx, or HFH (hazard ratio, 0.96 per 5% decrease; 95% CI, 0.93-0.99; P = .042). At 1-year follow-up, patients with reductions in LAVI of >10% and LAVI normalization (i.e., follow-up LAVI # 34 mL/m2; 31% of the overall cohort) were at lower risk for death, HTx, or HFH (hazard ratio, 0.37; 95% CI, 0.35-0.97; P = .028).Conclusions: In a large cohort of patients with DCM, 1-year reduction in LAVI was observed in a number of patients. The association between reduction in LAVI and death, HTx, or HFH suggests that LA structural reverse remodeling might be considered an additional parameter useful in the individualized risk stratification of patients with DCM. (J Am Soc Echocardiogr 2023;36:154-62.)

Automated summary

This study aimed to evaluate the prognostic implications of left atrial volume index (LAVI) reduction and found that a decrease in LAVI was associated with a reduced risk of mortality, heart transplantation, and heart failure hospitalization. The findings suggest that LAVI reduction may be an important parameter in risk stratification for patients with dilated cardiomyopathy.