In patients with advanced heart failure, impaired left atrial reservoir strain and increased minimum volume index were independently associated with a higher risk of death, LVAD implantation, or heart transplantation.
Observational (n=194)
No
Do echocardiographic left atrial indices predict adverse outcomes and exercise capacity in patients with advanced heart failure?
194 patients with advanced heart failure (LVEF ≤ 25%) referred for evaluation of advanced therapeutic options (LVAD or heart transplantation)
Echocardiographic assessment of left atrial indices (including left atrial reservoir strain [LASr], minimum volume index [LAVImin], ejection fraction [LAEF], and expansion index [LAEI])
Composite endpoint of all-cause death, LVAD implantation, or heart transplantationcomposite
Left atrial reservoir strain and minimum volume index provide independent prognostic value and correlate with exercise capacity in patients with advanced heart failure.
Tasa de eventos absoluta: 35.1% vs 14.4%
valor p: p=0.002
Left atrial (LA) remodeling and dysfunction are increasingly recognized as important contributors to outcomes in heart failure; however, their prognostic and functional relevance in advanced heart failure (AHF) remains insufficiently defined. This study evaluated the prognostic and functional significance of echocardiographic LA indices in AHF. Between 2021 and 2023, 194 patients with left ventricular ejection fraction ≤ 25% were included. All patients were referred to our tertiary cardiovascular center for evaluation of advanced therapeutic options left ventricular assist device (LVAD) or heart transplantation and underwent echocardiography, right heart catheterization, and cardiopulmonary exercise testing (CPET). Kaplan–Meier and Cox regression analyses were used to assess the prognostic impact of LA strain and mechanical indices on the composite endpoint of all-cause death, LVAD implantation, or heart transplantation. Correlations with CPET parameters were examined to evaluate functional relevance. Patients with impaired LA reservoir strain (LASr < 8.35%) exhibited more advanced atrial remodeling, higher filling pressures, worse ventricular function, and reduced exercise capacity. During a median follow-up of 461 days, adverse outcomes occurred more frequently in the lower LASr group (35.1% vs. 14.4%, p = 0.002). Both LASr and LA minimum volume index (LAVImin) independently predicted the composite endpoint and provided incremental prognostic value. LASr, LA ejection fraction (LAEF), and LA expansion index (LAEI) showed positive associations with peak VO₂ (all p < 0.001), indicating an association between atrial mechanics and exercise performance. In patients with AHF, LASr and LAVImin are independently associated with adverse clinical outcomes and reduced exercise tolerance. Incorporation of LA functional assessment into routine evaluation may help improve risk stratification and support clinical decision-making in this high-risk population.
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Murat Karaçam
State Hospital
Barkın Kültürsay
State Hospital
Azmican Kaya
Heart Failure & Transplant
Cardiovascular Ultrasound
SUNY Downstate Health Sciences University
State Hospital
Munzur University
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Karaçam et al. (Thu,) conducted a observational in Advanced heart failure (n=194). Lower left atrial reservoir strain (LASr < 8.35%) vs. Higher left atrial reservoir strain (LASr ≥ 8.35%) was evaluated on Composite of all-cause death, LVAD implantation, or heart transplantation (p=0.002). In patients with advanced heart failure, impaired left atrial reservoir strain and increased minimum volume index were independently associated with a higher risk of death, LVAD implantation, or heart transplantation.
synapsesocial.com/papers/6a1552bb79ff98d0de4e7167 — DOI: https://doi.org/10.1186/s12947-026-00366-6