Left Atrial Strain Outperforms Ventricular Strains in Cardiovascular Outcome Association Across Echocardiography and...

Cardiac chamber strain is associated with outcomes in various diseases. However, it remains uncertain whether left ventricular global longitudinal strain (LVGLS), left atrial reservoir strain (LASr), or right ventricular free wall longitudinal strain (RVfwLS) has the most robust association with outcomes.

The authors aimed to compare head-to-head the associations of LVGLS, LASr, and RVfwLS with major adverse cardiovascular events (MACE) using 2-dimensional speckle tracking echocardiography (2D-STE) and cardiac magnetic resonance feature tracking (CMR-FT).

Consecutive patients who underwent clinically indicated echocardiography and cardiac magnetic resonance on the same day were enrolled. Strain was derived from 2D-STE (fully automated and manually edited) and CMR-FT. The primary endpoint was MACE, including cardiac death, heart failure hospitalization, and sustained ventricular tachyarrhythmia.

We included 550 patients (age 65 ± 15 years, 361 [66%] male). Over a median follow-up of 2.2 years (Q1-Q3: 0.9-4.2 years), 78 (14.3%) patients experienced MACE. LVGLS, LASr, and RVfwLS were independently associated with MACE in separate models after adjusted for key clinical variables. Head-to-head comparisons of 3 strain parameters revealed that LASr remained significantly associated with MACE using 2D-STE (both fully automated and manually edited, HR: 0.91; 95% CI: 0.86-0.95) and CMR-FT (HR: 0.91; 95% CI: 0.86-0.96) (all P ≤ 0.001). Incremental analysis showed that LASr provided additional value beyond clinical parameters and LVGLS (all P < 0.001), while the subsequent addition of RVfwLS did not. Nomogram analyses indicated that LASr had the most significant impact on MACE compared with LVGLS and RVfwLS, as assessed by both 2D-STE and CMR.

Compared with LVGLS and RVfwLS, LASr exhibited the strongest association with MACE, regardless of the imaging modality used. Incorporating LASr as a routine measurement should therefore be considered.