The effect of icosapent ethyl on left atrial and left ventricular morphology

Spencer S Kitchin; Suvasini Lakshmanan; April Kinninger; Song S Mao; Mark G Rabbat; Deepak L Bhatt; Matthew J Budoff

doi:10.5837/bjc.2023.022

The effect of icosapent ethyl on left atrial and left ventricular morphology

Br J Cardiol. 2023 Jul 11;30(3):22. doi: 10.5837/bjc.2023.022. eCollection 2023.

Authors

Spencer S Kitchin¹, Suvasini Lakshmanan², April Kinninger³, Song S Mao⁴, Mark G Rabbat⁵, Deepak L Bhatt⁶, Matthew J Budoff⁷

Affiliations

¹ Resident Physician Department of Internal Medicine, Harbor-UCLA Medical Center, 1000 W Carson St, Box #400, Torrance, CA 90502, USA.
² Cardiovascular Disease Fellow Department of Internal Medicine, Division of Cardiovascular Medicine, Department of Internal Medicine, The University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242-1009, USA.
³ Statistician.
⁴ Physician.
⁵ Associate Professor Loyola University of Chicago, 2160 S 1 Ave, Maywood, IL 60153, USA.
⁶ Director of Mount Sinai Heart Icahn School of Medicine at Mount Sinai Health System, One Gustave L. Levy Place, New York, NY 10029-6574, USA.
⁷ Program Director and Director of Cardiac CT Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson St, Torrance, CA 90502, USA.

Abstract

Atrial fibrillation (AF) is a common arrhythmia associated with poor outcomes. N-3 fatty acids have been shown to provide significant cardiovascular risk reduction, but they may exacerbate the risk of AF. The pathway by which N-3 fatty acids may be arrhythmogenic is unknown. One possible mechanism involves cardiac chamber morphology alteration. The purpose of this study was to investigate the effect of icosapent ethyl (IPE) on left atrial (LA) size and left ventricular (LV) mass. This study used coronary computed tomographic angiography images gathered from the Effect of Icosapent Ethyl on Progression of Coronary Atherosclerosis (EVAPORATE) trial. EVAPORATE was a randomised, double-blind, placebo-controlled study finding a significant reduction in coronary atherosclerosis progression in patients with residually elevated triglycerides despite statin therapy on 4 g IPE daily versus 4 g placebo daily. Computed tomography images were used to measure LA size and LV mass at 0 and 18 months. Of 80 enrolled patients, 68 were included in the final analysis. Baseline demographics and risk factors were similar between IPE and placebo cohorts. LA anterior- posterior diameter measured on axial (p=0.51) and sagittal (p=0.52) orientations were not different over time. Also, there was no difference between groups in the change in LA volume (p=0.84). Change in LV mass was similar between groups (p=0.13). In conclusion, this study did not detect differences in LA size or LV mass over 18 months between patients on 4 g daily IPE versus placebo.

Keywords: atrial fibrillation; cardiac computed tomography; icosapent ethyl; polyunsaturated fatty acids.

Grants and funding

Funding EVAPORATE, from which this study utilised data and images, was funded by Amarin Pharma, Inc. (Bridgewater NJ, USA). As an investigator-initiated study (MJB), the company had no input in analysis, end point adjudication, or study performance or measures. Otherwise, this research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.