Prognostic value of left atrial reservoir strain for major adverse cardiovascular events in coronary artery disease

Coronary artery disease (CAD) is associated with a high burden of long-term adverse cardiovascular events. Traditional risk stratification relies primarily on left ventricular ejection fraction, a measure limited to systolic function; however, myocardial ischemia affects both systolic and diastolic mechanics. Left atrial reservoir strain (LASr) is an integrated marker of left atrial–left ventricular function with potential prognostic relevance in CAD. We conducted a systematic review and meta-analysis of studies evaluating LASr in patients with CAD. PubMed and Embase were searched from inception through November 2, 2025. Hazard ratios (HRs) for major adverse cardiovascular events (MACE) were pooled using random-effects models, with prespecified subgroup analyses, meta-regression, sensitivity analyses, and publication bias analyses. Seventeen studies comprising 9,404 patients were included. Fifteen studies enrolled acute coronary syndrome (ACS) populations, whereas two enrolled chronic coronary syndrome/stable CAD populations. In the primary ACS analysis using adjusted HRs, higher LASr was significantly associated with a lower risk of MACE (pooled HR per 1% increase = 0.94; 95% CI, 0.92–0.95; I 2 = 27%). This association was consistent across imaging modalities and timing of LASr assessment. A separate pooled analysis for chronic coronary syndrome/stable CAD was not performed because only two studies were available. Higher LASr was associated with a lower risk of MACE in patients with ACS, supporting its potential value as a prognostic marker in this population. Further studies are needed to clarify its role value in routine clinical practice.