Prognostic value of left atrial strain by speckle-tracking echocardiography in patients admited for heart failure

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Clinical practice guidelines support the diagnostic value of left atrial volume in preserved heart failure (HF), but there is little evidence in left atrial (LA) function prognostic usefulness. Some recent studies have proved the diagnostic and prognostic value of atrial strain independently of ejection fraction (EF) in patients with HF. Objectives We aim to assess the usefulness of measuring the LA reservoir function by echocardiogram with speckle-tracking in patients admitted for HF, both in sinus rhythm (SR) or atrial fibrillation (AF). First re-admission due to HF or cardiovascular mortality were evaluated as a combined primary endpoint during follow-up. Methods We conducted a prospective study of all patients admitted for HF during 12 months. The study of the LA reservoir function was analysed by peak atrial longitudinal strain (PALS) measurement, divided into tertiles, and biplane auricular EF. Results 122 patients were included (39% with reduced EF). Age 72±11 years, men 83(68%), AF 57(47%), previous HF 41(34%), with median follow-up 3.7 years. During follow-up, 65 cases (53%) were readmitted for HF and 14 (18%) died of cardiac causes. The univariate analysis showed significant differences in rhythm and atrial volume, but not with NT-proBNP nor left ventricular EF. The multivariate analysis adjusted for age, sex, rhythm, atrial volume, previous HF and LA EF showed a significant association between the minor tertile of PALS and admission for cardiac decompensation or death (HR 2.05; CI 95% 1.08–3.90; p = 0.028). Conclusions The study of atrial strain in HF is a prognostic marker of readmission for HF or cardiac death, assessable both in SR or AF. The minor tertile of PALS was associated significantly with the combined endpoint of re-admission due to HF and/or cardiovascular mortality.