Nuzzi Vincenzo, Raafs Anne, Manca Paolo, Henkens Michiel T H M, Gregorio Caterina, Boscutti Andrea, Verdonschot Job, Hazebroek Mark, Knackstedt Christian, Merlo Marco, Stolfo Davide, Sinagra Gianfranco, Heymans Stephane R B
Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy.
Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, the Netherlands.
J Am Soc Echocardiogr. 2023 Feb;36(2):154-162. doi: 10.1016/j.echo.2022.10.017. Epub 2022 Nov 2.
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).
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/m, and change in LAVI (ΔLAVI) was defined as the 1-year relative LAVI reduction. The outcome was a composite of death, heart transplantation (HTx), or heart failure hospitalization (HFH).
Five hundred sixty patients were included (mean age, 54 ± 13 years; mean left ventricular ejection fraction, 31 ± 10%; mean LAVI, 45 ± 18 mL/m). 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 ΔLAVI, -24%; interquartile range, -37% to -11%). Factors independently associated with ΔLAVI were higher baseline LAVI and lower baseline left ventricular ejection fraction. After multivariable adjustment, ΔLAVI 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/m; 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).
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.
在多种心血管疾病情况下，左心房（LA）扩张与预后较差相关，但治疗可促进LA逆向重构。本研究的目的是描述和确定扩张型心肌病（DCM）患者左心房容积指数（LAVI）降低的预后意义。
对来自两个三级医疗中心的连续DCM患者进行回顾性分析，这些患者在基线和1年随访时有可用的超声心动图。LA扩张定义为LAVI>34 mL/m²，LAVI变化（ΔLAVI）定义为1年相对LAVI降低。结局为死亡、心脏移植（HTx）或心力衰竭住院（HFH）的复合终点。
纳入560例患者（平均年龄54±13岁；平均左心室射血分数31±10%；平均LAVI 45±18 mL/m²）。基线LAVI与死亡、HTx或HFH风险呈非线性关联，独立于年龄、左心室射血分数、二尖瓣反流和药物治疗（P<.01）。在1年随访时，374例患者（67%）的LAVI降低（ΔLAVI中位数为-24%；四分位间距为-37%至-11%）。与ΔLAVI独立相关的因素是较高的基线LAVI和较低的基线左心室射血分数。多变量调整后，ΔLAVI与死亡、HTx或HFH风险呈线性关联（风险比为每降低5%为0.96；95%置信区间为0.93-0.99；P=.042）。在1年随访时，LAVI降低>10%且LAVI恢复正常（即随访LAVI≤34 mL/m²；占整个队列的31%）的患者死亡、HTx或HFH风险较低（风险比为0.37；95%置信区间为0.35-0.97；P=.028）。
在一大群DCM患者中，观察到一些患者的LAVI在1年内降低。LAVI降低与死亡、HTx或HFH之间的关联表明，LA结构逆向重构可能被视为DCM患者个体化风险分层中一个有用的额外参数。
