Prognostic Value of Left Atrial Strain in Heart Failure: A Systematic Review and Meta-Analysis

Abstract

BackgroundHeart failure (HF) is a global health problem with high morbidity and mortality. Recently, the association between peak atrial longitudinal strain (PALS) and clinical outcomes of HF has gained increasing attention. Our aim was to systematically assess the prognostic value of PALS for adverse events in HF.MethodsPubMed, Embase, and Scopus databases were systematically searched from inception to 30 April 2022. Studies in which PALS was assessed to predict adverse outcomes in adult patients with HF were included. Study selection, quality assessment, and data extraction were performed independently by two authors. The primary endpoints were all-cause death and cardiac hospitalization.ResultsAmong 7,787 patients in 17 included studies, 3,029 (38.9%) experienced the primary endpoint. Patients with events had lower PALS than those without events [weighted mean difference (WMD) 6.17, 95% confidence interval (CI) 3.09–9.26, p < 0.001]. Each unit increment of PALS was independently associated with decreased risk for the primary endpoint [hazard ratio (HR) 0.96, 95% CI 0.94–0.98, p < 0.001]. The addition of PALS significantly improved the predictive power of conventional risk models [net reclassification index (NRI) 0.22, 95% CI 0.06–0.39, p = 0.008].ConclusionPeak atrial longitudinal strain was an independent predictor for all-cause mortality and cardiac hospitalization in patients with HF, highlighting the clinical importance of left atrial (LA) deformation in the prognosis of HF.Systematic Review Registration[www.crd.york.ac.uk/prospero/], identifier [CRD42020185034].

Prognostic value of left atrial strain in aortic stenosis: A systematic review

“…PALS has been identified as a sensitive prognostic marker in many diseases including hypertension, diabetes, chronic renal disease, atrial fibrillation, cardiotoxicity, heart failure, and valvular heart disease. 12,[39][40][41] PALS has also been identified as a predictor of cardiovascular morbidity and mortality in the general population. 42 These disease states introduce cardiovascular pressure and volume overload or arrhythmic insult that can result in adverse atrial myocardial tissue remodeling.…”

“…A normal reference range for reservoir strain of 38%−41% has been shown in a previous meta‐analysis of healthy adults 11 . The prognostic value of PALS has been demonstrated in several clinical scenarios including cardiovascular events and heart failure 12,13 . There is now a growing body of evidence on the prognostic value of PALS in patients with AS.…”

Changes in left atrial function following two regimens of combined exercise training in patients with ischemic cardiomyopathy: a pilot study

“…Trying to revert the LA remodeling process by improving the LA structure and function is becoming an important goal in ICM management. This is because LA size and function have both emerged as prognostic factors in the general population and in patients with ICM ( 11 , 32 , 33 ). Exercise training has well proven the anti-remodeling effects in the post-ischemic LV ( 34 ), which are among the mechanisms through which exercise favorably impacts ICM.…”

“…Several studies demonstrated that the reservoir strain, which is often expressed as the peak atrial longitudinal strain (PALS), is impaired in a wide spectrum of cardiovascular conditions, with the highest degree of dysfunction being observed in patients with heart failure (HF) with both reduced and preserved ejection fractions (EF) ( 7 ). The impairment of PALS has been associated with a reduced exercise tolerance ( 8 ), a greater risk of atrial fibrillation insurgency ( 9 ), and a poor outcome ( 10 , 11 ). Similarly to PALS, the peak atrial contraction strain (PACS), reflecting the booster phase of the LA, has also recently been shown to predict survival in patients with cardiovascular diseases ( 12 ).…”

Left Atrial Strain Derived From Cardiac Magnetic Resonance Imaging Can Predict Outcomes of Patients With Acute Myocarditis

“…Previous studies demonstrated that impaired LA strain is associated with poor outcomes in patients with myocardial infarction, hypertrophic cardiomyopathy, valvular heart diseases, and heart failure as well as in the general population [ 13 14 28 29 30 31 ]. Schneider et al [ 32 ] demonstrated that the recovery of biatrial function by feature-tracking CMR strain analyses after acute myocarditis was independent of the clinical presentation.…”