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. 2022 Dec;9(6):3942-3953.
doi: 10.1002/ehf2.14106. Epub 2022 Aug 11.

Incremental prognostic value of left atrial strain in patients with heart failure

Kairui Bo  1 , Yifeng Gao  1 , Zhen Zhou  1 , Xuelian Gao  1 , Tong Liu  1   2 , Hongkai Zhang  1 , Qing Li  1 , Hui Wang  1 , Lei Xu  1
Affiliations

Incremental prognostic value of left atrial strain in patients with heart failure

Kairui Bo et al. ESC Heart Fail. 2022 Dec.

Abstract

Aims: The present study aimed to evaluate the prognostic value of atrial strain and strain rate (SR) parameters derived from cardiac magnetic resonance (CMR) feature tracking (FT) in patients with ischaemic and non-ischaemic dilated cardiomyopathy with heart failure with reduced ejection fraction (HFrEF) but without atrial fibrillation.

Methods and results: A total of 300 patients who underwent CMR with left ventricular ejection fraction (LVEF) ≤ 40% and ischaemic or non-ischaemic dilated cardiomyopathy were analysed in this retrospective study. Major adverse cardiac events (MACEs) include cardiovascular death, heart transplantation, and rehospitalization for worsening HF. Ninety-four patients had MACEs during median follow-up of 3.84 years. Multivariate Cox regression models adjusted for common clinical and CMR risk factors detected a significant association between LA-εs and MACE in ischaemic (HR = 0.94/%; P = 0.002), non-ischaemic dilated cardiomyopathy (HR = 0.88/%; P = 0.001), or all included patients (HR = 0.87; P < 0.001). LA-εs provided incremental prognostic value over conventional outcome predictors (Uno C statistical comparison model: from 0.776 to 0.801, P < 0.0001; net reclassification improvement: 0.075, 95% CI: 0.0262-0.1301). Kaplan-Meier analysis revealed that the risk of MACE occurrence increased significantly with lower tertiles of left atrial reservoir strain (LA-εs) (log-rank P < 0.0001). Patients in the worst LA-εs tertile faced a significantly increased risk of MACEs irrespective of late gadolinium enhancement (LGE) (log-rank P < 0.0001).

Conclusions: LA-εs derived from CMR FT has a significant prognostic impact on patients with ischaemic or non-ischaemic dilated cardiomyopathy, incremental to common clinical and CMR risk-factors.

Keywords: Cardiac magnetic resonance; Cardiomyopathy; Feature tracking; Left atrial strain; Prognosis.

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Conflict of interest statement

Kairui Bo, Yifeng Gao, Xuelian Gao, Zhen Zhou, Tong Liu, Hongkai Zhang, Qing Li, Hui Wang, and Lei Xu declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Measurement of atrial strain. The top panel shows a patient who died and the bottom panel shows a patient who survived.
Figure 2
Figure 2
ROC curve. The ROC curve for the overall performance of left atrial indexes for MACEs.
Figure 3
Figure 3
Kaplan–Meier survival curves. (A) Stratified by tertiles of LA‐εs in all patients. (B) Stratified by dichotomous of LA‐εs in ICM. (C) Stratified by dichotomous of LA‐εs in NIDCM.
Figure 4
Figure 4
Kaplan–Meier survival curves. (A) Stratified by LGE present in all patients. (B) Stratified by tertiles of LA‐εs and LGE present in all patients.
See this image and copyright information in PMC

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