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Updated: Jun 4, 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 predicts long-term heart failure outcomes after ST-elevation myocardial infarction
Kim W L M Ricken1, Chris Lenselink1, Constantijn S Venema1
1Department of Cardiology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands.
Insights
Left atrial reservoir strain is a valuable predictor of long-term heart failure risk after ST-elevation myocardial infarction (STEMI). Lower LA strain indicates higher risk, improving prediction models for better patient outcomes.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Heart Failure Research
Background:
- Left atrial (LA) strain reflects left ventricular function and is a potential predictor of heart failure.
- ST-elevation myocardial infarction (STEMI) is a critical condition requiring accurate prognostic markers.
- Assessing LA reservoir strain's impact on long-term outcomes post-STEMI is crucial.
Purpose of the Study:
- To evaluate the prognostic value of LA reservoir strain in predicting long-term heart failure events after STEMI.
- To determine if LA reservoir strain improves risk stratification in STEMI patients.
Main Methods:
- Two-dimensional speckle tracking echocardiography was used to measure LA reservoir strain in 287 STEMI patients.
- Patients were stratified by LA reservoir strain quartiles.
- Cox regression analysis identified predictors of a composite heart failure endpoint (cardiac death, hospitalization, new-onset HF).
Main Results:
- Lower LA reservoir strain was associated with older age and lower left ventricular ejection fraction (LVEF).
- Independent predictors of heart failure events included higher age, lower LVEF, lower diastolic blood pressure, and lower LA reservoir strain.
- Incorporating LA reservoir strain into risk models significantly enhanced predictive performance (C-statistic 0.838 vs. 0.784).
Conclusions:
- LA reservoir strain provides incremental prognostic value for long-term heart failure outcomes in STEMI survivors.
- This finding supports the use of LA reservoir strain in risk assessment for post-STEMI patients.
Background:
Left atrial (LA) strain reflects not only LA function but also systolic and diastolic left ventricular function. We therefore hypothesize that LA strain may be a comprehensive predictor of heart failure related endpoints after ST-elevation myocardial infarction (STEMI). We aim to assess the impact of LA reservoir strain on the long-term prognosis following ST-elevation myocardial infarction (STEMI).
Method And Results:
LA strain was measured in 287 first-time STEMI patients using two-dimensional speckle tracking echocardiography at hospitalization. Patients were categorized according to quartiles of LA reservoir strain for the analysis of population characteristics and assessment of event-free survival. Predictors of the composite heart failure endpoint of cardiac death, heart failure hospitalization, and new-onset heart failure were identified using Cox regression. The study population was 57.8 ± 11.3 years of age and predominantly male (74.6 %). After a median follow-up of 8.8 years, 33 (11.5 %) patients reached the composite endpoint. Mean LA reservoir strain was 27.5 ± 7.97 %. Patients with lower LA reservoir strain were older (p = 0.003) and had a lower left ventricular ejection fraction (LVEF, p < 0.001) at admission. Independent predictors for the composite endpoint were higher age (HR = 1.07, p = 0.001), lower LVEF (HR = 0.94, p = 0.015), lower diastolic blood pressure (HR = 0.97, p = 0.034), and lower LA reservoir strain (HR = 0.90, p = 0.003). Adding LA reservoir strain to a clinical risk prediction model significantly improved its performance (C-statistic 0.838 vs. 0.784, p = 0.003).
Conclusion:
The LA reservoir strain has incremental value in the prediction of long-term heart failure outcomes in patients after a first STEMI.
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