Left atrial strain determinants and clinical features according to the heart failure stages. New insight from EACVI MASCOT registry

Abstract

Few studies analyzed left atrial (LA) peak atrial longitudinal strain (PALS) determinants, particularly across heart failure (HF) stages. We aimed to analyze the pathophysiological and clinical PALS correlates in a large multicentric prospective study. This is a multicenter prospective observational study enrolling 745 patients with HF stages. Data included PALS and left ventricular global longitudinal strain (LV-GLS). Exclusion criteria were: valvular prosthesis; atrial fibrillation; cardiac transplantation; poor acoustic window. Median global PALS was 17% [24-32]. 29% of patients were in HF-stage 0/A, 35% in stage-B, and 36% in stage-C. Together with age, the echocardiographic determinants of PALS were LA volume and LV-GLS (overall model R² = 0.50, p < 0.0001). LV-GLS had the strongest association with PALS at multivariable analysis (beta: -3.60 ± 0.20, p < 0.0001). Among HF stages, LV-GLS remained the most important PALS predictor (p < 0.0001) whereas age was only associated with PALS in lower HF-stage 0/A or B (R = - 0.26 p < 0.0001, R = - 0.23 p = 0.0001). LA volume increased its association to PALS moving from stage 0/A (R = - 0.11; P = 0.1) to C (R = - 0.42; P < 0.0001). PALS was the single most potent echocardiographic parameter in predicting the HF stage (AUC for B vs. 0/A 0.81, and AUC vs. 0/A for C 0.76). PALS remained independently associated with HF stages after adjusting for ejection fraction, E/e' ratio, and mitral regurgitation grade (p < 0.0001). Although influenced by LV-GLS and LA size across HF stages, PALS is incrementally and independently associated with clinical status. LA function may reflect a substantial part of the hemodynamic consequences of ventricular dysfunction.

Keywords: Atrial function; Echocardiography; Heart failure.

Fig. 1

Representative example of two-dimensional STE–derived PALS measurements A and LV GLS B from an apical four-chamber view

Fig. 2

The figure summaries the most important PALS determinants

Fig. 3

Scatterplot illustrating the relationship between PALS and GLS. Colors identify four patients group based on the cohort’s median PALS and GLS. The green dots (preserved PALS and reduced GLS) are by far the less represented and crowded towards the fitting line

Fig. 4

Summary of the main PALS associated echocardiographic features and their interaction with H stage. Notably, as highlighted in the right panel, the age and LA volume effect on PALS is highly influenced by the HF stage, whereas GLS association with PALS remains stable in all HF stage

Fig. 5

Proportion of PALS/GLS grouping across HF stages. The absolute number of patients in each subgroup is reported within the columns