Prognostic value of temporal patterns of left atrial reservoir strain in patients with heart failure with reduced ejection fraction

S Abou Kamar; Y S Aga; M de Bakker; V J van den Berg; M Strachinaru; D Bowen; R Frowijn; K M Akkerhuis; J J Brugts; O Manintveld; V Umans; M Geleijnse; R A de Boer; E Boersma; I Kardys; B M van Dalen

doi:10.1007/s00392-023-02244-x

Prognostic value of temporal patterns of left atrial reservoir strain in patients with heart failure with reduced ejection fraction

Clin Res Cardiol. 2023 Jun 13. doi: 10.1007/s00392-023-02244-x. Online ahead of print.

Authors

S Abou Kamar^#^{1

2

3}, Y S Aga^#^{1

3}, M de Bakker¹, V J van den Berg^{1

4

5}, M Strachinaru¹, D Bowen¹, R Frowijn¹, K M Akkerhuis¹, J J Brugts¹, O Manintveld¹, V Umans⁴, M Geleijnse¹, R A de Boer¹, E Boersma¹, I Kardys^#⁶, B M van Dalen^#^{1

3}

Affiliations

¹ Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
² The Netherlands Heart Institute, Utrecht, The Netherlands.
³ Department of Cardiology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.
⁴ Department of Cardiology, Northwest Clinics, Alkmaar, The Netherlands.
⁵ Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands.
⁶ Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. i.kardys@erasmusmc.nl.

^# Contributed equally.

PMID: 37311973
DOI: 10.1007/s00392-023-02244-x

Abstract

Background: We investigated whether repeatedly measured left atrial reservoir strain (LASr) in heart failure with reduced ejection fraction (HFrEF) patients provides incremental prognostic value over a single baseline LASr value, and whether temporal patterns of LASr provide incremental prognostic value over temporal patterns of other echocardiographic markers and NT-proBNP.

Methods: In this prospective observational study, 153 patients underwent 6-monthly echocardiography, during a median follow-up of 2.5 years. Speckle tracking echocardiography was used to measure LASr. Hazard ratios (HRs) were calculated for LASr from Cox models (baseline) and joint models (repeated measurements). The primary endpoint (PEP) comprised HF hospitalization, left ventricular assist device, heart transplantation, and cardiovascular death.

Results: Mean age was 58 ± 11 years, 76% were men, 82% were in NYHA class I/II, mean LASr was 20.9% ± 11.3%, and mean LVEF was 29% ± 10%. PEP was reached by 50 patients. Baseline and repeated measurements of LASr (HR per SD change (95% CI) 0.20 (0.10-0.41) and (0.13 (0.10-0.29), respectively) were both significantly associated with the PEP, independent of both baseline and repeated measurements of other echo-parameters and NT-proBNP. Although LASr was persistently lower over time in patients with PEP, temporal trajectories did not diverge in patients with versus without the PEP as the PEP approached.

Conclusion: LASr was associated with adverse events in HFrEF patients, independent of baseline and repeated other echo-parameters and NT-proBNP. Temporal trajectories of LASr showed decreased but stable values in patients with the PEP, and do not provide incremental prognostic value for clinical practice compared to single measurements of LASr.

Keywords: Heart failure with reduced ejection fraction; Left atrial reservoir strain; Longitudinal studies; Repeated measurements.