Prognostic Role of Right Atrial Reservoir Strain in Acute Heart Failure

BACKGROUND: Right atrial (RA) dysfunction might indicate an advanced stage of heart failure (HF). The prognostic role of RA dysfunction, assessed according to RA reservoir strain (RArS), in hospitalized acute HF patients remains undetermined. METHODS: All consecutive patients hospitalized for acute HF were prospectively enrolled and had speckle-tracking echocardiography at discharge. The primary end point was all-cause mortality and HF rehospitalization. The patients were divided in 2 groups, on the basis of the RArS cutoff value derived from spline curve analysis. RESULTS: Of 401 patients (73.3 ± 12.1 years old; 60% male), 244 (55.1%) had RArS ≥ 11.4% and 177 (44.9%) had RArS < 11.4%. Worse left atrial and right ventricular (RV) function, larger RA size, and smaller left ventricular size were independently associated with RArS < 11.4%. During a median follow-up of 6 (interquartile range, 2.3-9.8) months, 141 (35.2%) patients reached the primary end point. Patients with RArS < 11.4% showed significantly higher percentage of cumulative events compared with patients with RArS ≥ 11.4% (49.2% vs 24.1%, respectively; log rank P < 0.001). Lower RArS was independently associated with the primary end point as a continuous (adjusted hazard ratio, 0.95 [95% confidence interval, 0.92-0.99]; P =0.006) and as a categorical (RArS <11.4%: adjusted hazard ratio, 1.80 [95% confidence interval, 1.05-3.08]; P = 0.032) variable. RArS provided incremental prognostic value over relevant clinical and echocardiographic variables including RV size, RV function, and RA size. CONCLUSIONS: Impaired RArS was independently associated with worse outcomes in hospitalized patients with acute HF. Its assessment before discharge could potentially allow refined risk stratification. CLINICAL TRIAL REGISTRATION: NCT05573997.