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Left Atrial Strain Predicts Cardiovascular and All-Cause Mortality
Chien-Wei Chang1,2, Wen-Hsien Lee2,3,4, Tien-Chi Huang2
1Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University.
Insights
Left atrial strain predicts mortality in patients, even those with borderline diastolic function. This study confirms its value as a survival predictor with extended follow-up.
Area of Science:
- Cardiology
- Echocardiography
- Cardiac Function Assessment
Background:
- Left atrial strain is a key indicator of left atrial function.
- Previous studies had limited follow-up periods and did not focus on patients with borderline diastolic function.
- This study aimed to assess left atrial strain's predictive value for mortality with a longer follow-up.
Purpose of the Study:
- To investigate the survival predictive value of left atrial strain using a longer follow-up duration.
- To evaluate the prognostic capability of left atrial strain in patients with borderline diastolic function.
Main Methods:
- 652 participants underwent 2-D speckle tracking echocardiography to assess left atrial reservoir function (peak atrial longitudinal strain).
- Study endpoints included all-cause and cardiovascular mortality.
- Median follow-up was 92 months.
Main Results:
- Lower left atrial strain was a significant predictor of both all-cause and cardiovascular mortality in univariable analysis.
- After adjusting for clinical and echocardiographic parameters, lower left atrial strain remained associated with increased all-cause (HR=0.942) and cardiovascular mortality (HR=0.915).
- Left atrial strain also predicted cardiovascular mortality in patients with borderline left ventricular diastolic function.
Conclusions:
- Left atrial strain is a valuable predictor of all-cause and cardiovascular mortality.
- Its predictive value persists even after adjusting for common clinical and echocardiographic factors.
- Left atrial strain is a significant prognostic marker, particularly in patients with borderline diastolic function.
Background:
Left atrial strain can usefully reflect left atrial function. The follow-up periods in previous studies assessing left atrial strain as a survival predictor have been relatively short, and few studies have examined the ability of left atrial strain to predict mortality in patients with borderline diastolic function. This study sought to investigate the survival predictive value of left atrial strain with a longer follow-up duration. In addition, we also evaluated the survival predictive value of left atrial strain in patients with borderline diastolic function.
Methods:
In total, 652 participants who received routine echocardiography underwent 2-D speckle tracking echocardiography to evaluate left atrial reservoir function by peak atrial longitudinal strain. The study endpoints were all-cause and cardiovascular mortality.
Results:
The mean left atrial strain was 27.6%, and the median follow-up duration was 92 months. During follow-up, 72 patients died of cardiovascular causes and 181 died of all causes. Univariable Cox regression analysis revealed that lower left atrial strain significantly predicted an increase in all-cause and cardiovascular mortality. After adjusting for common clinical and echocardiographic parameters, lower left atrial strain was still associated with a higher risk of all-cause mortality [hazard ratio (HR) = 0.942, p = 0.011] and cardiovascular mortality (HR = 0.915, p = 0.018) in multivariable Cox-regression analysis. In addition, 293 patients had borderline left ventricular diastolic function. Multivariable analysis still revealed that left atrial strain could predict cardiovascular mortality in this population.
Conclusions:
Our data showed that left atrial strain could predict all-cause and cardiovascular mortality, even after adjusting for general clinical and echocardiographic parameters.
