Left atrial myopathy predicts cardiovascular outcome in hypertension and diabetes

Arterial hypertension (AH) and type 2 diabetes mellitus (T2DM) predispose to left atrial (LA) dysfunction and atrial myopathy. We assessed the ability of peak atrial longitudinal strain (PALS) to predict major adverse cardiovascular events (MACEs) in AH and/or T2DM. We retrospectively enrolled patients > 40 years, in sinus rhythm, with AH and/or T2DM. Standard and advanced echocardiographic indices were collected; patients with previous MACEs, cardiac surgery, pacemakers, or moderate-to-severe valvular disease were excluded. The composite endpoint included atrial fibrillation, heart failure hospitalization, transient ischemic attack, stroke, myocardial infarction/coronary revascularization, and cardiovascular/all-cause mortality. Study population: 292 patients (63.0 ± 9.6 years, 50% female; 202 hypertensives, 167 diabetics, 77 with both). All patients had preserved left ventricular ejection fraction (58.2 ± 4.9), mild-to-moderate LA dilatation (52.9 ± 24.9 ml) and dysfunction (PALS 29.7 ± 11.1%). During 11.2 ± 1.3 years follow-up, 110 patients experienced ≥ 1 event; they had similar EF but were older (65.8 ± 9.0 vs. 61.3 ± 9.6 years, p < 0.001) and with poorer PALS (21.6 ± 7.7 vs. 34.6 ± 9.9%, p < 0.001) than those without events. On multivariate analysis, sex, age, systolic pulmonary artery pressure, and PALS were independently associated with outcomes, with PALS showing the strongest association (PALS < 22.5% HR 18.99; 22.5-30% HR 7.68; p < 0.001). Sex sub-analysis confirmed PALS powerful prognostic performance in women. PALS < 22.5% was related to 1-, 5-, and 10-year survival of 82.4%, 49.8% and 25.3%; for PALS > 30%: 100%, 98.5% and 92.5%. PALS, a surrogate marker of LA myopathy, is a strong prognosticator in patients with long standing T2DM and AH, thus should be routinely used in primary prevention.