Left ventricular and atrial strain and the risk of mortality and rehospitalization in heart failure

Global longitudinal strain (GLS) and left atrial strain metrics, including reservoir (LAr), contraction (LAct), and conduit strain (LAcd), have emerged as key indicators of left ventricular (LV) function and filling pressures. However, the prognostic value of these markers for risk stratification in acute heart failure (HF) remains uncertain, particularly in identifying patients at elevated risk of rehospitalization and mortality.

In the prospective HARVEST cohort study, LA strain and GLS measurements were obtained retrospectively in 141 patients (mean age 71 ± 13, 25% women). Strain values are reported as absolute values reflecting the magnitude of deformation regardless of sign. Multivariable adjusted Cox regression was used to test whether GLS, LAr, LAct, and LAcd were associated with all-cause mortality and HF rehospitalization. Hazard ratios were calculated per 1% decrease in strain values. During a median follow-up time of 39 (IQR 14-66) months (490 patient-years) for mortality analyses and 22 (IQR 4-51) months (354 patient-years) for HF rehospitalization 62 (44%) patients died, and 62 (44%) were rehospitalized. Higher GLS, LAr, and LAcd were associated with a lower risk of mortality (HR:0.94, 95%CI:0.89-0.99, p = 0.045; HR:0.93, 95%CI:0.89-0.98, p = 0.009; and HR:0.94, 95%CI:0.88-0.99, p = 0.039, respectively), and higher LAr and LAct were associated with reduced risk of HF rehospitalization (HR:0.93, 95%CI:0.88-0.98, p = 0.004; and HR:0.85, 95%CI:0.77-0.94, p = 0.002, respectively).

In patients with acute HF, strain parameters predict prognosis, with poorer outcomes. Notably, decreasing LAr was associated with increased risk of both death and rehospitalization for HF, whereas decreasing GLS was only associated with higher mortality risk.