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Published on: July 20, 2022
Prevalence, Determinants, and Prognostic Value of Left Atrial Dysfunction in Patients With Chronic Coronary Syndrome
Kazutoshi Hirose1, Koki Nakanishi1, Masao Daimon2
1Departments of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
Insights
Left atrial (LA) dysfunction, identified by LA reservoir strain, affects about 10% of chronic coronary syndrome (CCS) patients and predicts adverse cardiovascular events, even with normal heart function.
Area of Science:
- Cardiology
- Echocardiography
- Cardiovascular Disease Research
Background:
- Patients with chronic coronary syndrome (CCS) face ongoing cardiovascular disease (CVD) risks despite optimal treatment, necessitating better prognostic markers.
- Left atrial (LA) reservoir strain, measured by speckle-tracking echocardiography, shows promise as a sensitive indicator of CVD.
- The prognostic significance of LA dysfunction in CCS patients with preserved left ventricular (LV) function requires further investigation.
Purpose of the Study:
- To determine the prevalence, independent predictors, and prognostic implications of LA dysfunction in patients with CCS.
- To assess the association between LA reservoir strain and adverse cardiovascular outcomes.
- To evaluate LA dysfunction as a risk marker beyond traditional factors in this population.
Main Methods:
- A prospective study included 278 CCS patients post-percutaneous coronary intervention with preserved LV ejection fraction.
- Speckle-tracking echocardiography assessed LA reservoir strain; LA dysfunction was defined as ≤24%.
- Patients were followed for major adverse cardiovascular events (MACE), including new-onset atrial fibrillation, heart failure hospitalization, ACS, stroke, or all-cause death.
Main Results:
- LA dysfunction was present in 10.1% of patients at baseline.
- Independent determinants of LA reservoir strain included age, hypertension, LV ejection fraction, and multivessel disease.
- LA dysfunction was associated with a 3.10-fold increased risk of MACE (p=0.003), independent of other factors, and a 2.27-fold increased risk even excluding atrial fibrillation (p=0.043).
Conclusions:
- Approximately 10% of CCS patients with normal LV function exhibit LA dysfunction.
- LA dysfunction is a significant independent predictor of adverse cardiovascular outcomes in this cohort.
- Further research into therapeutic strategies targeting LA remodeling is warranted to mitigate CVD events.
Abstract:
Patients with chronic coronary syndrome (CCS), even when they have complete revascularization and normal left ventricular (LV) systolic function, experience subsequent cardiovascular disease (CVD), highlighting the importance of surrogate markers to prevent adverse consequences. Speckle-tracking echocardiography-derived left atrial (LA) reservoir strain has emerged as a sensitive marker for CVD in various clinical settings. The present study investigated the prevalence, determinants, and prognostic value of LA dysfunction in CCS. We included 278 consecutive patients with CCS with completed percutaneous coronary intervention and preserved LV ejection fraction who underwent follow-up echocardiography. Speckle-tracking analysis was performed to assess LA reservoir strain, and LA dysfunction was defined as LA reservoir strain ≤24%. The primary outcome comprised new-onset atrial fibrillation, heart failure hospitalization, acute coronary syndrome, stroke, or all-cause death. At baseline, 28 patients (10.1%) had LA dysfunction. Multivariable analysis identified age, hypertension, LV ejection fraction, and multivessel disease as independent determinants of LA reservoir strain (all p <0.05). During a median follow-up of 4.8 years, the primary outcome occurred in 60 patients (21.6%). LA dysfunction carried a significant risk for primary outcome independent of traditional risk factors, LV parameters, and LA size (adjusted hazard ratio 3.10, p = 0.003); the risk increase remained significant even after excluding atrial fibrillation from the primary outcome (adjusted hazard ratio 2.27, p = 0.043). In conclusion, approximately 10% of patients with CCS with normal LV ejection fraction had LA dysfunction associated with adverse cardiovascular outcomes. Further studies are needed to explore whether therapeutic interventions affecting LA remodeling may help prevent CVD events.
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