European Heart Journal Advance Access originally published online on October 24, 2007
European Heart Journal 2007 28(22):2738-2748; doi:10.1093/eurheartj/ehm443
Different effects of cardiac resynchronization therapy on left atrial function in patients with either idiopathic or ischaemic dilated cardiomyopathy: a two-dimensional speckle strain study
1 Monaldi Hospital, Second University of Naples, Via G. Martucci 35, 80121 Naples, Italy
2 Department of Internal Medicine and Public Health, University of L'Aquila, L'Aquila, Italy
3 Dipartimento di Internistica Clinica e Sperimentale, Sezione Scientifica di Diagnostica per Immagini, Second University of Naples, Naples, Italy
4 Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Naples, Italy
Received 28 February 2007; revised 23 July 2007; accepted 11 September 2007; online publish-ahead-of-print 24 October 2007.
* Corresponding author. Tel: +39 081 7618525; fax: +39 081 7145205. E-mail address: antonellodandrea{at}libero.it
Aims: In dilated cardiomyopathy (DCM), attenuation of left atrial (LA) booster pump function has been observed, and attributed both to altered LA loading conditions owing to left ventricular (LV) diastolic dysfunction and to LA involvement in the myopathic process. The aim of the present study was to detect LA systolic dysfunction in DCM using speckle-tracking two-dimensional strain echocardiography (2DSE), and to assess the effects of cardiac resynchronization therapy (CRT) on LA myocardial strain during 6 month follow-up.
Methods and results: A total of 90 patients (aged, 52.4 ± 10.2 years) with either idiopathic (n = 47) or ischaemic (n = 43) DCM underwent standard Doppler echo and 2DSE analysis of atrial longitudinal strain in the basal segments of LA septum and LA lateral wall, and in LA roof. The two groups were comparable for clinical variables (NYHA class: III in 72.2%; IV in 27.8%). LV volumes, ejection fraction, stroke volume, and mitral valve effective regurgitant orifice were similar between the two groups. No significant differences were evidenced in Doppler transmitral inflow measurements. LA diameter and maximal volume were also similar between the two groups. Conversely, LA active emptying volume and fraction were both lower in patients with idiopathic DCM. Peak systolic myocardial atrial strain was significantly compromised in patients with idiopathic DCM compared with ischaemic DCM in all the analysed atrial segments (P < 0.001). At follow-up, 64 patients (71.1%) (37 idiopathic and 27 ischaemic) were responders, and 26 (28.9%) (10 idiopathic; 16 ischaemic) were non-responders to CRT (responder: decrease of LV end-systolic volume >15%). A significant improvement in LA systolic function was obtained only in patients with ischaemic DCM responders to CRT (P < 0.001). By multivariable analysis, in the overall population, it was found that ischaemic aetiology of DCM (ß-cofficient = 0.62; P < 0.0001) and positive response to CRT (ß-cofficient = 0.42; P < 0.01) were the only independent determinants of LA lateral wall systolic strain.
Conclusions: Two-dimensional strain represents a promising non-invasive technique to assess LA atrial myocardial function in patients with DCM. LA pump and reservoir function at baseline and after CRT are more depressed in idiopathic compared with ischaemic DCM patients. Future longitudinal studies are warranted to understand further the natural history of LA myocardial function, the extent of reversibility of LA dysfunction with CRT, and the possible prognostic impact of such indexes in patients with congestive heart failure.
Key Words: Heart failure • Resynchronization therapy • Idiopathic dilated cardiomyopathy • Two-dimensionalstrain imaging • Left atrium • Left atrial function
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