In HFrEF patients, each 1% increase in left atrial reservoir and contractile strain reduced all-cause mortality risk (HR 0.96 and 0.95 respectively) with incremental prognostic value.
Does left atrial strain (reservoir and contractile) predict all-cause mortality in patients with HFrEF?
Left atrial reservoir and contractile strain provide incremental prognostic value for predicting all-cause mortality in patients with HFrEF beyond established clinical and echocardiographic parameters.
Background The prognostic value of left atrial (LA) strain in patients with heart failure with reduced ejection fraction (HFrEF) has not been fully elucidated. Therefore, this study investigated the prognostic value of LA strain in HFrEF patients in relation to all-cause mortality. Methods A total of 822 echocardiograms from HFrEF patients admitted to a heart failure clinic were analysed offline. To calculate left atrial reservoir strain (LA RS) and left atrial contractile strain (LA CS), LA two-dimensional speckle tracking was performed in the 4-chamber, 2-chamber and 3-chamber view. The end-point was all-cause mortality. The association between LA strain parameters and outcome was examined using Cox regression. Results The median follow-up time was 40 months and follow-up was 100% complete. During follow-up, a total of 137 patients (16.7%) died of all causes. In a final multivariable model adjusted for clinical and echocardiographic parameters including global longitudinal strain, LA RS and LA CS were significantly associated with all-cause death during follow-up (LA RS, HR 0.96, 95% CI 0.92 to 0.99, p=0.014, pr. 1% increase) (LA CS, HR 0.95, 95% CI 0.92 to 0.98, p=0.002, pr. 1% increase). When added to the final multivariable model, both LA RS and LA CS contributed with incremental prognostic value as determined by C-statistic (LA RS: C-stat difference 0.007, 95% CI 0.000 to 0.020, p=0.050) (LA CS: C-stat difference 0.009, 95% CI 0.000 to 0.023, p=0.030). Conclusion In HFrEF patients, LA RS and LA CS were associated with all-cause mortality and contributed incremental prognostic value in addition to established prognostic measures.
Özbek et al. (2026) studied this question. In HFrEF patients, each 1% increase in left atrial reservoir and contractile strain reduced all-cause mortality risk (HR 0.96 and 0.95 respectively) with incremental prognostic value.