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Left Atrial Function in Pediatric Cardiomyopathies: A Multicenter Study
Jolanda Sabatino1, Martina Avesani2, Sara Moscatelli3
1Pediatric and Congenital Cardiology Unit, Department for Women's and Children's Health, University Hospital of Padova, Padova, Italy; Pediatric Research Institute (IRP) "Città della Speranza", Padua, Italy; Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy.
Insights
Left atrial reservoir strain (LAS) is a valuable predictor of adverse outcomes in pediatric cardiomyopathy patients, offering insights beyond traditional echocardiographic measures for improved risk stratification.
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.
Aims:
The association between left ventricular (LV) systolic dysfunction and adverse outcomes in pediatric cardiomyopathies (CMs) has been well established, but little is known about the prognostic value of the diastolic function in this population. This study aims to evaluate the association between left atrial (LA) function, assessed through 2D speckle-tracking echocardiography (2D-STE), and adverse outcomes in pediatric CM patients.
Methods:
A retrospective study of 138 pediatric CM patients (dilated, hypertrophic, and restrictive CMs) and 45 controls from 3 institutions was conducted. Echocardiographic parameters, including LA reservoir strain (LAS), were measured from each patient's oldest complete echocardiogram at each institution. The primary composite end point was cardiovascular death or aborted death, the need for a ventricular assist device, or cardiac transplantation. Associations between LAS and outcomes were assessed using Cox proportional hazards models and Kaplan-Meier analysis; complementary receiver operating characteristic curves were computed after adjustment for follow-up duration.
Results:
During a median follow-up of 78.8 months, 25 patients experienced the composite end point. Lower LAS (P < .001), impaired global longitudinal strain (GLS; P = .003), reduced LV ejection fraction (LVEF; P = .003), and increased LA volume index (LAVi; P = .027) and E/e' (P = .024) were significantly associated with adverse outcomes. Multivariable Cox analysis demonstrated that LAS (hazard ratio, 0.90 [0.84-0.96]; P = .001) is independently associated with the combined end point in model A adjusted for E/A and E/e', in model B (hazard ratio, 0.94 [0.89-0.99]; P = .018) adjusted for LAVi and LVEF, and in model C (hazard ratio, 0.91 [0.87-0.95]; P < .001) adjusted for GLS and LVEF. Left atrial reservoir strain performed better than LAVi in determining the association with outcomes, with an area under the curve of 0.739 (P < .001) and a cutoff of 15.3% (sensitivity, 0.58; specificity, 0.86).
Conclusion:
Left atrial reservoir strain showed an adjusted association with adverse outcomes in pediatric patients within the specified models, providing incremental information beyond conventional echocardiographic parameters. Incorporating LAS into routine evaluations may improve risk stratification and guide early interventions in pediatric CM.
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