Prognostic value of left atrial strain in heart failure with reduced ejection fraction

Abstract Background The prognostic value of left atrial (LA) strain in patients with heart failure with reduced ejection fraction (HFrEF) has not been fully elucidated. Therefore, this study investigated the prognostic value of left atrial strain in HFrEF patients in relation to allcause mortality. Methods A total of 822 echocardiograms from HFrEF patients admitted to a heart failure clinic were analyzed offline. To calculate left atrial resevoir strain (LA RS) and left atrial contractile strain (LA CS), left atrial two-dimensional speckle tracking was performed in the 4-chamber, 2-chamber and 3-chamber view. The end-point was all-cause mortality. The association between left atrial strain parameters and outcome was examined using Cox regression. Results The median follow-up time was 40 months and follow-up was 100% complete. During follow-up, a total of 137 patients (16.7%) died of all causes. In a final multivariable model adjusted for clinical and echocardiographic parameters including global longitudinal strain, LA RS and LA CS were significantly associated with all-cause death during follow-up (LA RS, HR 0.96, 95% CI 0.92-0.99 p = 0.014, pr. 1% increase) (LACS, HR 0.95, 95% CI 0.92-0.98 p = 0.002, pr. 1% increase) (Table 1). When added to the final multivariable model, both LA RS and LA CS contributed with incremental prognostic value as determined by C-statistic (LA RS: C-stat difference 0.007, 95% CI 0.000-0.020, p = 0.050) (LA CS: C-stat difference 0.009, 95% CI 0.000-0.023, p = 0.030). Conclusion In HFrEF patients, LA RS and LA CS were associated with all-cause mortality and contributed with incremental prognostic value in addition to established prognostic measures.Table 1