Abstract 16571: An Appraisal on Prognostic Value of Left Atrial Strain in Exercise Echocardiography

Introduction: Diastolic dysfunction impairs exercise capacity and has prognostic value in exercise echocardiography. We aimed to assess whether left atrial strain (LAS), which is reduced with worsening in diastolic function, is associated with all-cause death or heart failure hospitalization in patients undergoing treadmill echocardiography. Methods: We performed 2D-speckle tracking analysis of LAS in 1636 consecutive patients (mean age 64±13 and 59% men) who underwent treadmill echocardiography between 1/2013 and 1/2014. We used the 2016 ASE recommendation to define diastolic function and elevated LV filling pressure. Results: Of 1636 study subjects, 95% had LV ejection fraction ≥ 50%. Diastolic function was normal in 44% of patients and abnormal in the remaining (23% grade I, 9% grade II, 1% grade III, and 23% indeterminate). During a mean follow-up of 5.5±1.8 years, 210 patients (12.8%) experienced the composite outcome (157 death and 88 heart failure hospitalization). Lower LASreseroivr, LASbooster and LA emptying fraction (LAEF) were all associated with increased risk for the adverse outcome independent of age, sex, clinical and echocardiographic parameters, and after further adjustment for diastolic function (abnormal vs. normal) (all p≤0.001). The association of LASbooster with the outcome attenuated in a model with LASreservoir or LAEF (both p>0.1). Adding LASreservoir to clinical and echocardiographic parameters provided incremental prognostic value (continuous net reclassification improvement=0.09, p=0.04), but not LAEF or LASbooster. Patients with LASreservoir <34.2% (lowest tertile) had more than doubled risk for death or heart failure hospitalization than those with LASreservoir ≥34.2% after multivariable adjustment in the entire cohort (adjusted hazard ratio 2.2, 95%CI: 1.53 - 3.23), as well as in those with normal stress test (n=1217, adjusted HR, 3.53, 95%CI: 2.29 - 5.53) or those without elevated resting LV filling pressure (n=1466, adjusted HR: 2.08, 95%CI: 1.46 - 2.96). Conclusions: LASreservoir provides independent prognostic information in patients undergoing exercise echocardiography.

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P1526Pre-dialysis left atrial function assessed by two-dimensional speckle tracking echocardiography as a predictor of upcoming heart failure in hemodialysis patients

European Heart Journal ◽

10.1093/eurheartj/ehz748.0288 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

H Park ◽

M Kim ◽

H K Jeong ◽

K H Kim ◽

J Y Cho ◽

...

Keyword(s):

Heart Failure ◽

Diastolic Function ◽

Left Atrial ◽

Speckle Tracking ◽

Prognostic Value ◽

Speckle Tracking Echocardiography ◽

Hemodialysis Patients ◽

Volume Index ◽

Hemodialysis Session ◽

Echocardiographic Parameters

Abstract Background Left atrial global longitudinal strain (LA GLS) by 2-dimensional speckle tracking echocardiography is a useful tool to assess LA function and left ventricular (LV) diastolic function. The authors assessed prognostic value of LA GLS, and other diastolic functional parameters in patients undergoing hemodialysis. Methods A total of 78 (49 male) patients undergoing hemodialysis who checked echocardiography due to heart failure (HF) symptoms were included for this analysis. Echocardiography wasperformed at the same day of, and before hemodialysis session. Besides conventional echocardiographic measurements, GLS of the LA and the LV were checked and compared. Incidence of rehospitalization due to HF symptoms during mean follow up duration of 381.4±197.5 days was investigated and echocardiographic parameters were compared between patients who experienced rehospitalization and who did not. Results 16 (20.1%) patients experienced rehospitalization due to HF. HF rehospitalization group had significantly low baseline LV ejection fraction (55.7±7.2 vs. 61.3±7.1%, p=0.006) and LV GLS (14.7±3.4 vs. 18.2±3.9%, p=0.002), while LV geometry (LV end-diastolic volume index and LV wall thickness) did not show significant differences. In HF rehospitalization group, baseline LA function and diastolic function were significantly impaired as reflected by LA GLS (18.8±2.6 vs. 23.8±3.6%, p<0.001), E/E' ratio (20.8±3.3 vs. 15.8±4.6%, p<0.001), and right ventricular systolic pressure (61.4±9.6 vs. 53.4±12.8%, p=0.022). LA end-systolic volume index was not significantly different between the 2 groups. Among various echocardiographic parameters, receiver operation characteristic curve analysis revealed that LA GLS had the strongest power (cutoff value 20.6%, sensitivity 0.813 and specificity 0.790, area under curve 0.849) in prediction of future rehospitalization due to HF. Predictor of future HF: ROC analysis Conclusions The present study demonstrated that functional changes of the LA as measured by LA GLS before hemodialysis session can be used as an echocardiographic parameter to predict future rehospitalization due to HF. Further studies are required to evaluate prognostic value of LA function in predicting other cardiovascular events in hemodialysis patients.

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Prognostic Value of Left Atrial Strain in Outpatients with De Novo Heart Failure

Journal of the American Society of Echocardiography ◽

10.1016/j.echo.2016.07.012 ◽

2016 ◽

Vol 29 (11) ◽

pp. 1035-1042.e1 ◽

Cited By ~ 19

Author(s):

Laura Sanchis ◽

Rut Andrea ◽

Carlos Falces ◽

Teresa Lopez-Sobrino ◽

Silvia Montserrat ◽

...

Keyword(s):

Heart Failure ◽

Left Atrial ◽

Prognostic Value ◽

De Novo ◽

Left Atrial Strain ◽

Atrial Strain

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P177 Left atrial strain in patients with cardiac amyloidosis. Relationship to left atrial amyloid deposition focusing on prognosis

European Heart Journal ◽

10.1093/ehjci/ehz872.058 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

Author(s):

K Misumi ◽

H Miura ◽

Y Morita ◽

H Amano ◽

H I Ueda ◽

...

Keyword(s):

Heart Failure ◽

Left Atrial ◽

Cardiac Amyloidosis ◽

Longitudinal Strain ◽

Amyloid Fibrils ◽

Prognostic Significance ◽

Amyloid Deposit ◽

Heart Failure Hospitalization ◽

Left Atrial Strain ◽

Atrial Strain

Abstract Background In cardiac amyloidosis (CA), the left atrium (LA) is frequently infiltrated by the amyloid fibrils. It is currently known that LA strain is a marker of LA function and prognosis in many cardiac diseases, however its significance in CA remains unknown. Purpose Our aim was to investigate correlation between LA strain measured by Cardiovascular Magnetic Resonance (CMR) and amyloid deposit in LA, and also evaluate the LA strain on the prognostic significance. Methods and results Of 74 consecutive patients with biopsy-proven CA, we analyzed 42 patients (age 72 ± 10 years; 76 % males) with contrast-enhanced CMR, and examined LA late gadolinium enhancement (LGE) and CMR derived LA strain using feature tracking method. Of the 42 patients, 29 patients (69 %) was transthyretin cardiac amyloidosis (ATTR-CA) in the majority. We divided these 42 patients into two groups according to the CMR measured peak atrial longitudinal strain (PALS) (> = or < median); high-strain (> = 6.67 %, n = 21) and low-strain (＜ 6.67 %, n = 21) and compared the patient’s characteristics, blood test data, echocardiography and CMR parameters. There were no significant differences between two groups in these parameters but in the extent of LA-LGE (54 % vs 80 %, p = 0.008). The PALS correlated with the extent of LA-LGE (ρ= 0.50, p = 0.001). In multivariate analysis including LVEF, E/e’ and BNP, LA-LGE was an independent determinant of PALS. During three-year follow up, the LA strain significantly related to heart failure hospitalization in the ATTR-CA patients (p = 0.036)(Figure). Conclusions In CA patients, CMR measured LA longitudinal strain correlates with the LA-LGE. It also provides useful information for poor prognosis of patients with ATTR-CA. Abstract P177 Figure. Heart failure hospitalization in ATTR-CA

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P1482Preclinical diastolic dysfunction assessed by left atrial strain and association with incident heart failure

European Heart Journal ◽

10.1093/eurheartj/ehz748.0247 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

E Potter ◽

S Ramkumar ◽

H Yang ◽

H Kawakami ◽

K Negishi ◽

...

Keyword(s):

Heart Failure ◽

Diastolic Dysfunction ◽

Diastolic Function ◽

Left Atrial ◽

Left Ventricular ◽

Community Dwelling ◽

Volume Index ◽

P Value ◽

Left Atrial Strain ◽

Atrial Strain

Abstract Background Left atrial strain in the reservoir phase (LASr) measures passive LA stretch and is a sensitive marker of left ventricular diastolic dysfunction (DD). However, reduced LASr has not been prospectively validated against clinical heart failure (HF) endpoints and its place in diastology evaluation is unclear. Aim We sought whether DD grades defined by previously validated ranges of LASr predicted incident HF and whether reclassifying indeterminate diastolic function based on reduced LASr could facilitate assessment of HF risk. Methods Community dwelling elderly subjects were recruited and underwent baseline clinical and echocardiographic assessment. Where imaging was suitable, speckle-tracking echocardiography assessed LASr and subjects were assigned DD grades based on published ranges: normal >35%, grade 1 24–35%, grade 2 19–24%, grade 3 <19%. Current ASE/EACVI recommendations were used to identify those with indeterminate function; LASr-defined DD (LASr-DD) was defined as LASr ≤23%. Follow-up was ≤2 years and incident HF adjudicated by Framingham criteria. Results Of 610 subjects (age 71±5 yrs., 46% male) LASr analysis was feasible in 590 (97%); average LASr was 39% (IQR 34–43%). Incident HF was associated with LASr-DD grade, occurring in 8 (36%) with grade ≥2, 14 (10%) with grade 1 and 39 (9%) with normal function (p<0.001). Adjusted odds ratio for incident HF for LASr-DD grade ≥2 was 3.12 (95% CI 1.06–9.1, p=0.038) Diastolic function was indeterminate in 147 (24%) subjects; of 144 (98%) with LAS analysis, 6 (75%) of those with LASr-DD vs. 15 (11%) with normal LASr experienced incident HF (p<0.001). Univariable Multivariable* OR (95% CI) p-value OR (95% CI) p-value LASr-DD grade: 1 1.13 (0.59–2.15) 0.7 0.84 (0.42–1.69) 0.63 ≥2 5.7 (2.26–14.5) <0.001 3.12 (1.06–9.1) 0.038 *Adjusted for age, hypertension, diabetes, BMI, global longitudinal strain, E/e', LA volume index, LV mass index (all p<0.1 on univariable analysis). Incorporating LA strain in practice Conclusion DD defined by LASr is predictive of HF for grades ≥2 independent of other diastolic measures. Indeterminate diastolic function with LASr ≤23% is associated with incident HF. LASr may complement current diastolic function assessment recommendations. Acknowledgement/Funding Baker Heart and Diabetes Institute

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