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. 2020 Nov;13(11):2316-2326.
doi: 10.1016/j.jcmg.2020.04.028. Epub 2020 Aug 5.

Association of Asymptomatic Diastolic Dysfunction Assessed by Left Atrial Strain With Incident Heart Failure

Elizabeth L Potter  1 , Satish Ramkumar  1 , Hiroshi Kawakami  1 , Hong Yang  2 , Leah Wright  3 , Tomoko Negishi  4 , Thomas H Marwick  5
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Free article

Association of Asymptomatic Diastolic Dysfunction Assessed by Left Atrial Strain With Incident Heart Failure

Elizabeth L Potter et al. JACC Cardiovasc Imaging. 2020 Nov.
Free article

Abstract

Objectives: This study is to establish the association of left atrial reservoir strain (LARS) with incident heart failure (HF), and the impact of substituting LARS for left atrial (LA) volume index (LAVI) in diastolic assessment.

Background: LARS measures passive LA stretch and is a sensitive marker of left ventricular diastolic dysfunction (DD). The potential contribution of LARS to diastolic assessment is unclear.

Methods: Baseline clinical and echocardiographic assessments were obtained in 758 asymptomatic, community-dwelling elderly subjects (age 70 [interquartile range: 67 to 74] years, 53% women) with nonischemic HF risk factors. LARS-defined DD (LARS-DD) was assessed by speckle-tracking echocardiography, and grades were assigned as normal (>35%), grade 1 (25% to 35%) and grade 2 (≤24%). DD grade using current recommendations was compared with grading using LARS <24% in place of LAVI >34 ml/m2. Patients were followed for up to 2 years for incident HF.

Results: LA strain analysis was feasible in 738 (97%) patients; average LARS was 39% (range 34% to 43%). Incident HF was associated with LARS-DD grade; 8 (36%) of those had grade 2+, 14 (10%) had grade 1, and 39 (9%) had normal function (p < 0.001). LARS-DD grade 2+ predicted incident HF after adjustment for clinical and echocardiographic markers (adjusted hazard ratio: 2.5; 95% confidence interval: 1.02 to 6.3; p = 0.049); there was no significant HF risk associated with LARS-DD grade 1. Dichotomized abnormal LARS <24% had an adjusted hazard ratio of 2.9 (95% confidence interval: 1.25 to 6.79; p = 0.013). Substituting LARS for LAVI provided a 75% reduction in indeterminate diastolic function; all were recategorized as normal. There was no increased risk associated normal diastolic function by this grading compared to conventional grading (C-statistic = 0.76 for both models).

Conclusions: LARS-DD grade 2+ is associated with incident HF in the elderly, independent of LAVI. The substitution of LARS for LAVI reduces the number of indeterminate cases without impacting prognosis in normal diastolic function and grade 1 DD.

Keywords: diastolic dysfunction; heart failure; left atrial strain.

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Conflict of interest statement

Author Relationship With Industry The work was partially supported by a Partnership grant (1149692) from the National Health and Medical Research Council, Canberra, the Ian Potter Foundation, Melbourne, and the Baker Heart and Diabetes Institute. Dr. Potter is supported by a Monash University postgraduate scholarship. Dr. Marwick has received personal fees from GE Medical Systems. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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