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Updated: Jul 2, 2025
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Left atrial strain is associated with long-term mortality in acute coronary syndrome patients
Philip Rüssell Pedersson1,2, Kristoffer Grundtvig Skaarup3,4, Mats Christian Højbjerg Lassen3,4
1Department of Cardiology, Copenhagen University Hospital-Herlev & Gentofte, Gentofte Hospitalsvej 8 3Th, Post 835, DK-2900, Copenhagen, Denmark. prp_1212@hotmail.com.
Insights
Reduced left atrial (LA) strain, including peak atrial longitudinal strain (PALS) and peak conduit strain (PCS), predicts long-term mortality in acute coronary syndrome (ACS) patients after percutaneous coronary intervention (PCI). These LA strain indices offer valuable prognostic information for ACS survivors.
Area of Science:
- Cardiology
- Echocardiography
- Cardiac Imaging
Background:
- Acute coronary syndrome (ACS) poses significant long-term mortality risks.
- Left atrial (LA) function assessed by strain parameters may offer prognostic insights.
- The prognostic value of specific LA strain indices in ACS patients post-percutaneous coronary intervention (PCI) requires further elucidation.
Purpose of the Study:
- To evaluate the long-term prognostic significance of LA strain indices, specifically peak atrial longitudinal strain (PALS), peak conduit strain (PCS), and peak atrial contractile strain (PACS), in relation to all-cause mortality.
- To determine the association between reduced LA function and long-term survival in ACS patients treated with PCI.
Main Methods:
- Retrospective analysis of 371 ACS patients who underwent PCI and echocardiography.
- Exclusion of patients with non-sinus rhythm, missing images, or inadequate image quality for LA 2D speckle tracking.
- Multivariable Cox regression analysis to assess the relationship between PALS, PCS, PACS, and all-cause mortality over a median follow-up of 5.7 years.
Main Results:
- Reduced PALS and PCS were significantly associated with increased all-cause mortality (HR 1.04 and 1.05 per 1% decrease, respectively).
- PACS demonstrated a non-linear association, with increased mortality risk observed when PACS was below 18.22%.
- These associations persisted even in patients with a left atrial volume index below 34 ml/m².
Conclusions:
- Reduced LA strain, assessed by PALS and PCS, is a significant independent predictor of long-term all-cause mortality in ACS patients post-PCI.
- PACS also provides prognostic information, particularly at lower values.
- LA strain parameters are valuable tools for risk stratification in ACS survivors, aiding in the identification of patients at higher risk for adverse long-term outcomes.
Abstract:
To investigate the long-term prognostic value of the left atrial (LA) strain indices - peak atrial longitudinal strain (PALS), peak conduit strain (PCS), and peak atrial contractile strain (PACS) in acute coronary syndrome (ACS) patients in relation to all-cause mortality. This retrospective study included ACS patients treated with percutaneous coronary intervention (PCI) and examined with echocardiography. Exclusion criteria were non-sinus rhythm during echocardiography, missing images, and inadequate image quality for 2D speckle tracking analysis of the LA. The endpoint was all-cause death. Multivariable Cox regression which included relevant clinical and echocardiographic measures was utilized to assess the relationship between LA strain parameters and all-cause mortality. A total of 371 were included. Mean age was 64 years and 76% were male. Median time to echocardiography was 2 days following PCI. During a median follow-up of 5.7 years, 83 (22.4%) patients died. Following multivariable analysis, PALS (HR 1.04, 1.01-1.06, p = 0.002, per 1% decrease) and PCS (HR 1.05, 1.01-1.09, p = 0.006, per 1% decrease) remained significantly associated with all-cause mortality. PALS and PCS showed a linear relationship with the outcome whereas PACS was associated with the outcome in a non-linear fashion such that the risk of death increased when PACS < 18.22%. All LA strain parameters remained associated with worse survival rate when restricting analysis to patients with left atrial volume index < 34 ml/m2. Reduced LA function as assessed by PALS, PCS, and PACS were associated with an increased risk of long-term mortality in patients with ACS.
