Abstract 17811: Biomarkers Are Superior to Left Atrial Strain Predicting Outcomes in a Multi-Ethnic HFpEF Population

Abstract

Introduction: In heart failure with preserved ejection fraction (HFpEF) atrial mechanics play an important role in diastolic dysfunction, and impaired atrial function is related to increased levels of atrial biomarkers such as NT-proBNP. We studied the predictive value of atrial function assessed by speckle-tracking strain and compared it to biomarkers in a multiethnic HFpEF population. Methods: We studied 237 consecutive patients who were admitted with acute decompensated heart failure and EF > 50. The average age was 78±11, 69% of patients were female, and 36% (n=86) were non-Hispanic Black (NHB); 30% (n=71) Hispanic; 21% (n=50) non-Hispanic White (NHW) and 13% (n=30) Other. Left ventricular (LV), atrial (LA), and right atrial (RA) volumes, ejection fraction, and global longitudinal strain (GLS) were measured. During a two-year follow-up, heart failure readmissions and death were registered. Results: Most patients (n= 202) had an abnormal LA-EF of < 45% and abnormal RA-EF <46% (n=205). During a follow-up period of 2 years, 55 patients died, 28% Hispanic, 20% NHB, 20% NHW, and 17% Other. LA-GLS was impaired in all HFpEF patients (13.5+8.2) and was not associated with event-free survival (Figure) in the entire cohort or in any race/ethnicity subgroups. However, increased NT-proBNP (1,200 pg/mL) was associated with worst outcomes (p < 0.01) (Figure). Conclusions: In a multiethnic HFpEF cohort, LA function was universally impaired but had no prognostic value. In contrast, elevated NT-proBNP at hospital discharge predicted recurrent hospitalization and death.