Background This study aimed to evaluate the association of peak exercise left atrial (LA) reservoir strain with clinical outcomes in patients with heart failure (HF), and the prognostic value across HF phenotypes. Methods We enrolled 150 patients with HF (age 67 ± 15 years, 61% males) who underwent exercise stress echocardiography. LA reservoir strain at rest and peak workload were evaluated using the speckle-tracking echocardiography. The endpoint was a composite of cardiovascular death or hospitalization for HF. Results During a median follow-up of 1.1 years (interquartile range 0.7–2.4 years), 49 patients experienced events. Patients were categorized into two groups on the basis of the median value of LA reservoir strain at peak workload of 16.7%. Kaplan–Meier curves showed that patients with low LA reservoir strain at peak workload had a higher event rate than those with high LA reservoir strain (log-rank test, P < 0.001). LA reservoir strain at peak workload was independently associated with events (hazard ratio: 5.57, 95% confidence intervals: 2.74–11.3, P < 0.001), and provided the incremental prognostic value over clinical factors. When analyzed according to HF phenotype, LA reservoir strain at peak workload was significantly associated with events in both patients with HFpEF and those with HFrEF, with a significant interaction between HF phenotype and LA reservoir strain at peak workload. Conclusion LA reservoir strain at peak workload has prognostic value for adverse outcomes in both HFpEF and HFrEF.
Yu Yoshida, Y. Takaya, R. Nakayama et al.· International Journal of Car...· 0 citations
Left atrial (LA) stiffness integrates information related to LA mechanical properties and left ventricular (LV) filling dynamics and may provide a comprehensive assessment of cardiac hemodynamic burden in heart failure (HF). However, its clinical significance in patients with chronic HF and impaired LV systolic function remains unclear. We investigated the association between the LA stiffness index (LASI) and clinical outcomes in patients with chronic HF and impaired LV systolic function. We retrospectively analyzed 1,147 patients with chronic HF and left ventricular ejection fraction (LVEF) <50% who underwent comprehensive echocardiography between January 2018 and March 2023. LASI was calculated as the ratio of E/e' to LA reservoir strain and stratified into tertiles. The primary endpoint was a composite of cardiovascular death or HF hospitalization. Kaplan-Meier analysis and Cox proportional hazards models were used to evaluate the association between LASI and clinical outcomes. During a median follow-up of 34 months, 218 patients experienced the primary endpoint. Event-free survival progressively decreased across LASI tertiles (log-rank P < 0.01). After adjustment for age, sex, LVEF, LA volume index, and tricuspid regurgitation velocity, higher LASI remained independently associated with adverse outcomes (hazard ratio 2.41, 95% confidence interval 1.55-3.73, P < 0.01). This association was consistent across clinically relevant subgroups, including age, diabetes mellitus, LV geometry, and LA size. In conclusion, in patients with chronic HF and impaired LV systolic function, increased LASI was independently associated with cardiovascular death and HF hospitalization, suggesting that LASI may serve as a practical echocardiographic marker reflecting atrial dysfunction and hemodynamic burden.
R. Nakayama, Y. Takaya, M. Nakashima et al.· American Journal of Cardiolo...· 1 citation
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