Prognostic value of left atrial strain quantification from 2D ultrasound imaging in post-ischemic heart failure patients: evidence from the REMODEL-HF study.
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Frigelli M, Sturla F, Milani V, Ramputi L, Citarella M, Menicanti L, Votta E, Castelvecchio S. Prognostic value of left atrial strain quantification from 2D ultrasound imaging in post-ischemic heart failure patients: evidence from the REMODEL-HF study. Int J Cardiol. 2022 Sep 1;362:183-189. doi: 10.1016/j.ijcard.2022.04.071. Epub 2022 Apr 30. PMID: 35504452. Abstract <strong>Background: </strong>Left atrial (LA) function can be effectively assessed by measuring longitudinal LA strain (LAS) via two-dimensional speckle tracking echocardiography (2DSTE). Here, we test 2DSTE-based LAS as marker of different left ventricle (LV) remodeling patterns and as prognostic index in ischemic heart failure (HF) candidates to surgical ventricular reconstruction. <strong>Methods: </strong>We retrospectively considered ischemic HF patients with anterior (group A, n=130) or posterior (group P, n=48) LV remodeling. Based on 2D ultrasound, LV and LA morpho-functional parameters were quantified including reservoir (LAS<sub>Res</sub>), conduit (LAS<sub>Cond</sub>) and booster (LAS<sub>Boost</sub>) LAS. We tested their capability to discriminate between groups A and P, and their group-specific prognostic significance for the composite end-point of death or HF re-hospitalization at follow-up (mean follow-up time=40 months, range 3-101 months). <strong>Results: </strong>Group A and group P displayed similar end-diastolic (p=0.89) and end-systolic (p=0.33) LV volume index, and LA volume index LAVi (p=0.44) corrected for the degree of mitral regurgitation. As compared to group P, group A revealed a significant reduction in LAS<sub>Boost</sub> (9.2±0.4% vs. 11.1±0.7%, p=0.04) and a non-significant reduction in LAS<sub>Res</sub> (16.9±0.7% vs. 19.3±1.1%, p=0.06). Kaplan-Meier curves showed that the median LAS<sub>Res</sub> and LAS<sub>Boost</sub> values effectively stratified patients based on their prognosis in the overall study population (Log-rank p=0.002 and Log_rank p<0.0001) and in group A, where the association was stronger for LAS<sub>Boost</sub> (Log-rank p<0.001) than for LAS<sub>Res</sub> (Log-rank p=0.013). <strong>Conclusions: </strong>2DSTE-based LAS assessment is affordable, repeatable and non-invasive, and could add clinically-relevant mechanistic insight and prognostic value in the stratification of ischemic HF patients.
