Key result
Reduced global left atrial strain independently predicted the composite of HF hospitalization and all-cause mortality in HFpEF (OR 4.15; 95% CI 1.2-14; P=0.023).
Why the study?
Are impaired left atrial mechanics associated with the pro-fibrotic ST2 marker and outcomes in patients with HFpEF?
Cohort (n=86)
Yes
Are impaired left atrial mechanics associated with the pro-fibrotic ST2 marker and outcomes in patients with HFpEF?
Effect estimate: OR 4.15 (95% CI 1.2-14)
p-value: p=0.023
In HFpEF, impaired left atrial mechanics, rather than left ventricular parameters, correlate with the pro-fibrotic biomarker ST2 and independently predict heart failure hospitalization and mortality.
May aid HFpEF risk stratification; hypothesis-generating and requires prospective validation before practice change.
AIMS: Left ventricular (LV) mechanics have been extensively investigated in heart failure with preserved ejection fraction (HFpEF) overshadowing for a long time the potential role of left atrium (LA) in that setting. Soluble suppression of tumorigenicity-2 receptor (ST2) is a novel biomarker of pro-fibrotic burden in HF. We hypothesized that due to the thinner LA wall, the fibrotic myocardial changes in HFpEF as indicated by elevated ST2 levels might more readily be reflected by impairments in the LA rather than the LV performance. METHODS AND RESULTS: In 86 patients with HFpEF, enrolled in the Karolinska Rennes (KaRen) biomarker prospective substudy, global LA strain (GL-LS) along with other echocardiographic as well as haemodynamic parameters and ST2 levels were measured. ST2 levels were inversely associated with LA-GS (r = -0.30, P = 0.009), but not with LA size, LV geometry, systolic or diastolic LV function (P > 0.05 for all). Furthermore, symptom severity correlated with ST2 and LA-GS, but not with LV structural or functional indices. Finally, during a median 18-month follow-up, LA-GS independently predicted the composite endpoint of HF hospitalization and all-cause mortality, even after adjustment for potential clinical and cardiac mechanical confounders, including LV global longitudinal strain and filling pressures (odds ratio: 4.15; confidence interval: 1.2-14, P = 0.023). CONCLUSIONS: Reduced LA-GS but not LV functional systolic and diastolic parameters were associated with the pro-fibrotic ST2 marker, HF symptoms and outcome in HFpEF.
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Nagy et al. (2018) conducted a cohort in Heart failure with preserved ejection fraction (HFpEF) (n=86). Global left atrial strain (LA-GS) was evaluated on Composite of HF hospitalization and all-cause mortality (OR 4.15, 95% CI 1.2-14, p=0.023). Reduced global left atrial strain independently predicted the composite of HF hospitalization and all-cause mortality in HFpEF (OR 4.15; 95% CI 1.2-14; P=0.023).
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