Speckle Tracking-Derived Left Atrial Stiffness Predicts Clinical Outcome in Heart Failure Patients with Reduced to Mid-Range Ejection Fraction

Abstract

Background and Aim: Left atrial stiffness (LASt) is an important marker of cardiac function, especially in patients with heart failure (HF); it explains symptoms on the basis of pressure transfer to the pulmonary circulation. The aim of this study was to evaluate the relationship between LASt and cardiac events (CE) in HF patients with reduced to mid-range ejection fraction. Methods: The study included 215 consecutive ambulatory HF patients with ejection fraction (EF) < 50% (162 HF reduced EF and 53 HF mid-range EF) of mean age 66 ± 11 years and 24.4% females. Peak LA strain (PALS) was measured by speckle tracking echocardiography and E/e’ recorded from the apical four-chamber view. Non-invasive LASt was calculated using the equation: LASt = E/e’ ratio/PALS. Documented cardiac events (CE) were HF hospitalization and cardiac death. Results: During a median follow up of 41 ± 34 months, 65 patients (30%) had CE. In multivariate analysis model, only raised LV filling pressure (E/e’) (OR = 0.292, (95% CI 0.099 to 0.859), p = 0.02), peak pulmonary artery pressure (PAP) (OR = 1.050 (1.009 to 1.094), p = 0.01), PALS (OR = 0.932 (0.873 to 0.994), p = 0.02) and LASt (OR = 3.781 (1.144 to 5.122), p = 0.001) independently predicted CE. LASt ≥ 0.76% was the most powerful predictor of CE, with 80% sensitivity and 73% specificity (AUC 0.82, CI = 0.73 to 0.87, p < 0.001) followed by PALS ≤ 16%, with 74% sensitivity and 72% specificity (AUC 0.77, CI = 0.71 to 0.84, p < 0.001). These results were consistent irrespective of EF (p < 0.05). Conclusion: In this cohort of ambulatory HFrEF and HFmrEF patients, LASt proved the most powerful predictor of clinical outcome.

Impaired left atrial stiffness in patients with corrected congenital left ventricular outflow obstructions

“…In a recent study, Reddy et al found that LA Stiff may be the best echocardiographic correlate of elevated filling pressures in patients with preserved LVEF 19 . Finally, abnormal LA Stiff values were associated with an increased incidence of cardiac events 8 and were a strong predictor of atrial fibrillation recurrence 20 . Combining E/Ea and LAS, LA Stiff is strongly influenced by LV properties 21 and is mainly modulated by LV longitudinal function through the downward motion of the mitral plane during ventricular systole.…”

“…LA Stiff showed a more robust correlation with the extent of LA fibrosis than LA strain 7 . The prognostic utility and clinical relevance of LA Stiff have been recently emphasized 8,9 . However, LA Stiff has not yet been investigated in patients with c‐LVOO correction, a specific population at risk of premature LV and LA dysfunction.…”

Multi-modality assessment and role of left atrial function as an imaging biomarker in cardiovascular disease

“…LAS_r has also been used in calculating a surrogate of LA stiffness (calculated as the ratio of E/e’ to LAS_r) [ 52 , 87 , 88 ]. LA stiffness was a strong predictor of adverse outcomes (death and HF hospitalization) in a study of 215 HF patients [ 87 ].…”

Left atrial stiffness predicts cardiac events in patients with heart failure and reduced ejection fraction: The impact of diabetes

“…Such changes, in the absence of mitral valve disease, reflect significant diastolic LV disease and raised diastolic pressures. (Bytyçi et al., 2020 Apr 25; Khurraml et al., 2016; Melenovsky et al., 2015) Being chronic in nature and perpetual in deterioration, the LA response to increased cavity pressure is in the form of enlargement, remodelling and finally fibrosis. (Bytyçi et al., 2019) These changes result in worsening cavity function including contraction and stiffness, which eventually result in raised cavity pressure and pulmonary venous hypertension.…”