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. 2023 Feb;45(1):613-625.
doi: 10.1007/s11357-022-00673-6. Epub 2022 Dec 9.

Long-term prognostic value of left atrial longitudinal strain in an elderly community-based cohort

Fjolla Zhubi Bakija  1   2 , Zsolt Bagyura  1 , Alexandra Fábián  1 , Andrea Ferencz  1 , Loretta Kiss  1 , Orsolya Szenczi  1 , Réka Vadas  3 , Edit Dósa  1 , Dat Tin Nguyen  1 , Csaba Csobay-Novák  1 , Ádám L Jermendy  1 , Zsolt Szelid  1 , Pál Soós  1 , Attila Kovács  4 , Béla Merkely  5
Affiliations

Long-term prognostic value of left atrial longitudinal strain in an elderly community-based cohort

Fjolla Zhubi Bakija et al. Geroscience. 2023 Feb.

Abstract

Despite the well-known importance of left atrial (LA) mechanics in diastolic function, data are scarce regarding the prognostic power of LA longitudinal strain and its potential added value in the risk stratification of an elderly population. Accordingly, our aim was to determine the long-term prognostic importance of 2D speckle-tracking echocardiography-derived peak atrial longitudinal strain (PALS) in a community-based screening sample. Three hundred and fourteen volunteers were retrospectively identified from a population-based screening program (mean age 62 ± 11 years; 58% female) with a median follow-up of 9.5 years. All subjects who participated in the screening program underwent 2D echocardiography to measure left ventricular (LV) ejection fraction (EF), global longitudinal strain (GLS), and PALS, as well as low-dose cardiac CT to determine the Agatston score. The primary endpoint was all-cause mortality. Thirty-nine subjects (12.4%) met the primary endpoint. Subjects with adverse outcomes had significantly lower LV GLS (dead vs. alive; - 19.2 ± 4.3 vs. - 20.6 ± 3.5%, p < 0.05) and PALS (32.3 ± 12.0 vs. 41.8 ± 14.2%, p < 0.001), whereas LV EF did not show a difference between the two groups (51.1 ± 7.0 vs. 52.1 ± 6.2, %, p = NS). By multivariable Cox regression analysis, PALS was found to be a significant predictor of adverse outcomes independent of LV GLS, and Agatston and Framingham scores. In subjects with PALS values below the standard cut-off of 39%, the risk of all-cause mortality was almost 2.5 times higher (hazard ratio: 2.499 [95% confidence interval: 1.334-4.682], p < 0.05). Beyond the assessment of LV EF and LV GLS, PALS offers incremental value in cardiovascular risk stratification in a community-based elderly cohort. PALS was found to be a significant and independent predictor of long-term mortality among other classical cardiovascular risk estimators.

Keywords: Diastolic dysfunction; Echocardiography; Global longitudinal strain; Mortality; Risk stratification.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Kaplan–Meier survival curves using a standard cut-off value of 39%
Fig. 2
Fig. 2
Receiver operating characteristic curve illustrating the discriminatory power of PALS with regard to the endpoint. Youden’s index was used to identify the optimal cut-off point of 32.6%
Fig. 3
Fig. 3
Kaplan–Meier survival curves based on the optimal cut-off value (32.6%) of PALS assessed with receiver operating characteristic analysis
Fig. 4
Fig. 4
Representative cases of subjects below (indicated with red) and above 39% (indicated with green) of peak atrial longitudinal strain (PALS). Subject with 12.6% PALS met the primary endpoint during the follow-up period. The blue contour on the 2D echocardiographic image depicts left atrial (LA) endocardial border at end-systole
See this image and copyright information in PMC

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