Archives of the Turkish Society of Cardiology
Effect of Cardiac Resynchronization Therapy on Left Atrial Spontaneous Echo Contrast Left Atrial Reverse Remodeling and Left Atrial Total Emptying Fraction [Turk Kardiyol Dern Ars]
Turk Kardiyol Dern Ars. 2003; 31(6): 305-315

Effect of Cardiac Resynchronization Therapy on Left Atrial Spontaneous Echo Contrast Left Atrial Reverse Remodeling and Left Atrial Total Emptying Fraction

Ahmet Vural1, Ayşen Ağaçdiken1, Dilek Ural1, Tayfun Şahin1, Güliz Kozdağ1, Göksel Kahraman1, Ertan Ural1, Haluk Akbaş1, Kaya Sezer1, Baki Komsuoğlu1

Cardiac resynchronization therapy restores ventricular synchrony and has beneficial effects on left ventricular systolic function. Recent studies revealed a reverse remodeling in left ventricle with cardiac resynchronization therapy. However, changes in left atrial remodeling and effects spontaneous echo contrast (SEC) have not been adequately evaluated. The aim of this study was to investigate the long-term effects of cardiac resynchronization therapy on left atrial SEC, left atrial reverse remodeling, left atrial total emptying fraction, left ventricular systolic function and reverse remodeling in patients with dilated cardiomyopathy and left bundle-branch block. Material and methods: Fifteen patients with New York Heart Association Class III to IV, a left ventricular ejection fraction < 35%, complete left bundle-branch block, and a QRS >150 ms underwent implantation of biventricular pacemaker devices. Transthoracic and transesophageal echocardiography (TEE) were performed one week and before one and six months of pacemaker implantation. Exercise testing was performed with Naughton protocol one week before and one and six months after pacemaker implantation. Parameters one and six months after biventricular pacemaker implantation were compared with basal parameters.
RESULTS
After biventricular pacemaker implantation, significant clinical improvement and significant increase in exercise duration were observed in all patients. Left ventricular end-systolic and end-diastolic dimensions and left ventricular end-systolic and end-diastolic volumes significantly decreased one and six months after biventricular pacemaker implantation. Left ventricular ejection fraction, fractional shortening and cardiac index also increased after implantation. Mitral regurgitation was significantly reduced after implantation. Left atrial minimum and left atrial maximum volumes significantly decreased one and six months after biventricular pacemaker implantation. There was no change in left atrial maximum long diameter measured from the apical 4-chamber view. Left atrial minimum long diameter from the apical 4-chamber view significantly diminished six months after implantation. Left atrial diameter measured from parasternal long axis view progressively decreased in the follow-up period. Left atrial total emptying fraction increased, and frequency and intensity of SEC gradually decreased after biventricular pacemaker implantation. We concluded that cardiac resynchronization therapy results in atrial and ventricular reverse remodeling, increases atrial total emptying fraction and left ventricular systolic function, and reduces frequency and intensity of atrial SEC

Keywords: Left atrial SEC, left atrial systolic function, reverse remodeling

How to cite this article
Ahmet Vural, Ayşen Ağaçdiken, Dilek Ural, Tayfun Şahin, Güliz Kozdağ, Göksel Kahraman, Ertan Ural, Haluk Akbaş, Kaya Sezer, Baki Komsuoğlu. Effect of Cardiac Resynchronization Therapy on Left Atrial Spontaneous Echo Contrast Left Atrial Reverse Remodeling and Left Atrial Total Emptying Fraction. Turk Kardiyol Dern Ars. 2003; 31(6): 305-315
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