Prognostic Value of Left Atrial Strain in Outpatients with De Novo Heart Failure

Left atrial (LA) dysfunction has been related to symptom onset in patients with heart failure (HF). However, the potential prognostic role of LA function has been scarcely studied in outpatients with new-onset HF symptoms.

Consecutive outpatients with suspected HF onset evaluated at a one-stop clinic were screened. HF diagnosis was performed according to current guidelines. LA function was analyzed in patients in sinus rhythm by speckle-tracking echocardiography, determining LA peak strain rate after atrial contraction (LASRa) as a surrogate of atrial contractile function. Yearly prospective follow-up was conducted to report cardiovascular hospital admission or death. Patients without HF in sinus rhythm were followed as a control group. Survival curves were estimated using the Kaplan-Meier method.

One hundred fifty-four outpatients were included (mean age, 74 ± 10 years; 67% women) with a median follow-up duration of 44.4 months (interquartile range, 31-58 months). Final diagnosis was 29.9% non-HF and 70.1% HF. More than two in five patients with HF (44.4%) had AF (n = 48), and 55.6% (n = 60) were in sinus rhythm. The latter were divided according to LASRa tertile: highest, -1.93 ± 0.39 sec^-1; middle, -1.08 ± 0.21 sec^-1; and lowest, -0.47 ± 0.18 sec^-1. At the end of follow-up, patients with atrial fibrillation had a low event-free survival rate (56.3%), similar to those in the lower LASRa tertile (55.0%). The non-HF group had the best prognosis, and the higher and middle LASRa tertiles had intermediate prognoses (event-free survival, 85%, 75%, and 70%, respectively).

The study of contractile LA function in outpatients with new-onset HF provides prognostic stratification. The early identification of patients at higher risk on the basis of their atrial function would allow focusing on them independently of their final diagnoses.