Risk stratifying systemic sclerosis-related pulmonary hypertension by left atrial strain.

Area of Science:

• Cardiology
• Rheumatology
• Pulmonary Medicine

Background:

• Systemic sclerosis-associated pulmonary hypertension (SSc-PH) poses significant mortality risks.
• Left ventricular (LV) diastolic function is crucial in SSc-PH prognosis.
• Left atrial (LA) strain is a sensitive indicator of diastolic dysfunction.

Purpose of the Study:

• To investigate the utility of LA global longitudinal strain (GLS) components in risk stratifying SSc-PH patients.
• To explore the association between distinct LA strain patterns and all-cause mortality.

Main Methods:

• Retrospective analysis of 124 SSc-PH patients confirmed by right heart catheterization.
• Quantification and K-means clustering of LA GLS components (reservoir, conduit, contractile).
• Kaplan-Meier and Cox proportional hazards models to assess survival outcomes.

Main Results:

• Three LA GLS clusters were identified, differing in median LA conduit and contractile strain.
• Significant survival differences were observed between clusters (log-rank p=0.005).
• Cluster 3, characterized by the lowest contractile strain, had the shortest median survival (48.4 months) and a higher adjusted hazard ratio for mortality (2.57).

Conclusions:

• LA GLS clustering provides valuable prognostic information in SSc-PH.
• The lowest LA contractile strain is associated with significantly reduced survival.
• LA GLS offers a potential tool for enhanced risk stratification in SSc-PH management.