Left Atrial Function in Pediatric Cardiomyopathies: A Multicenter Study

Area of Science:

• Cardiology
• Pediatric Cardiology
• Echocardiography

Background:

• Left ventricular systolic dysfunction is linked to poor outcomes in pediatric cardiomyopathies.
• The prognostic role of diastolic function, specifically left atrial function, remains underexplored in this population.

Purpose of the Study:

• To assess the association between left atrial (LA) function, measured by 2D-speckle tracking echocardiography (2D-STE), and adverse outcomes in pediatric cardiomyopathy patients.
• To determine if LA function provides incremental prognostic information compared to conventional echocardiographic parameters.

Main Methods:

• Retrospective analysis of 138 pediatric cardiomyopathy patients and 45 controls.
• Measurement of LA reservoir strain (LAS) and other echocardiographic parameters (GLS, LVEF, LAVi, E/e') from baseline echocardiograms.
• Composite endpoint: cardiovascular death, aborted death, VAD implantation, or cardiac transplantation, analyzed using Cox models and ROC curves.

Main Results:

• Lower LAS was significantly associated with adverse outcomes (p<0.001).
• LAS independently predicted adverse outcomes in multivariable analyses, outperforming LA volume index (LAVi).
• LAS demonstrated an Area Under the Curve (AUC) of 0.739 for outcome prediction.

Conclusions:

• Left atrial reservoir strain (LAS) is independently associated with adverse outcomes in pediatric cardiomyopathy.
• LAS provides incremental prognostic value beyond conventional echocardiographic measures.
• Routine incorporation of LAS may enhance risk stratification and guide early interventions in pediatric cardiomyopathy.