Combined left and right atrial reservoir strain identifies a high-risk phenotype in patients with chronic heart...

Atrial reservoir strain reflects atrial compliance and global cardiac filling pressure. Although left atrial reservoir strain (LASr) has been associated with adverse outcomes in heart failure (HF), the prognostic significance of combined left and right atrial reservoir strain remains unclear.

We retrospectively analyzed 1147 patients with chronic HF and left ventricular ejection fraction (LVEF) < 50% who underwent comprehensive transthoracic echocardiography between January 2018 and May 2023. LASr and right atrial reservoir strain (RASr) were assessed using two-dimensional speckle-tracking echocardiography. Patients were stratified into four groups according to high or low LASr and RASr based on median values. The primary endpoint was a composite of cardiac death or HF hospitalization. Event-free survival rate was evaluated using Kaplan-Meier analysis and associations with outcomes were assessed using Cox proportional hazards models.

During a median follow-up of 34 months, 221 composite events occurred. Event-free survival differed significantly among the four groups (log-rank test, P < 0.01). Patients with concomitantly low LASr and low RASr had the highest risk of cardiac death or HF hospitalization. After adjustment for age, sex, LVEF, left atrial volume index and tricuspid regurgitation velocity, combined low LASr and low RASr remained independently associated with adverse outcomes (hazard ratio 2.43, 95% confidence interval 1.64-3.61; P < 0.01).

Combined assessment of LASr and RASr identified a distinct high-risk phenotype in patients with chronic HF and reduced LVEF. Bi-atrial reservoir strain provides clinically relevant prognostic information beyond conventional echocardiographic measures and may improve risk stratification.