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Left atrial strain in non-ischemic dilated cardiomyopathy in sinus rhythm: Prognostic implications and

Eduard Ródenas-Alesina1, Jordi Lozano-Torres1, Clara Badia-Molins1

  • 1Department of Cardiology, Vall d'Hebron University Hospital, Department of Medicine, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain.

International Journal of Cardiology
|November 23, 2024
PubMed

Insights

Left atrial contraction strain (PACS) is a key predictor of adverse events in non-ischemic dilated cardiomyopathy (NIDCM). Lower PACS values indicate higher risk, especially when combined with left ventricular global longitudinal strain (LV-GLS).

Area of Science:

  • Cardiology
  • Echocardiography
  • Heart Failure Research

Background:

  • Left atrial (LA) deformation analysis aids in risk stratification for adverse events in non-ischemic dilated cardiomyopathy (NIDCM).
  • Assessing peak longitudinal strain (PALS) and peak atrial contraction strain (PACS) in NIDCM is crucial for understanding cardiac function.

Purpose of the Study:

  • To determine the association between PALS and PACS in NIDCM patients.
  • To evaluate this association while accounting for left ventricular global longitudinal strain (LV-GLS).

Main Methods:

  • Included consecutive NIDCM patients with sinus rhythm and LVEF <50%.
  • Measured PALS, PACS, and LV-GLS using echocardiography.
  • Utilized Cox regression and classification and regression tree (CART) analysis for outcome assessment.

Main Results:

  • A composite outcome occurred in 20.2% of patients over a median follow-up of 3.6 years.
  • PACS ≤8% was significantly associated with the composite outcome (HR=2.73), primarily driven by heart failure admissions.
  • LV-GLS increased composite outcome risk in patients with PACS >8% (HR=1.20).
  • PALS correlated more strongly with LV-GLS (rho=-0.71) than PACS (rho=-0.5).
  • A decreased PALS/LV-GLS ratio was linked to higher composite outcome rates.

Conclusions:

  • LA dysfunction is a major determinant of adverse outcomes in NIDCM patients with LVEF <50%.
  • Routine assessment of LA strain is recommended.
  • PACS may be a more effective predictor than PALS when combined with LV-GLS, potentially due to reduced dependence on mitral annular motion.
Abstract

Keywords:
EchocardiographyHeart failureLeft atrial strainLeft ventricular strainNon-ischemic dilated cardiomyopathy

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