Combined Left Ventricular and Left Atrial Strain Assessment for Long‐Term Risk Stratification in Heart Failure With Reduced Ejection Fraction

PURPOSE: Left ventricular (LV) global longitudinal strain (GLS) and left atrial reservoir strain (LASr) are established predictors of adverse outcomes in heart failure with reduced ejection fraction (HFrEF), but the prognostic value of their combined assessment has not been fully elucidated. METHODS: This retrospective study included 341 patients hospitalized with decompensated HFrEF who underwent speckle-tracking echocardiography for assessment of LV GLS and LASr. Receiver operating characteristic (ROC) analysis with Youden index optimization was applied to determine optimal strain cutoff values and develop a combined strain classification model. Cox proportional hazards models were used to identify parameters associated with all-cause mortality. LV GLS was analyzed using absolute values. RESULTS: During a median follow-up of 59 months, 238 patients (70%) died. In univariable analysis, both LV GLS and LASr were associated with mortality. After multivariable adjustment, both remained independently associated with mortality (GLS: adjusted HR 0.945, 95% CI 0.902-0.991, p = 0.019; LASr: adjusted HR 0.972, 95% CI 0.953-0.992, p = 0.006). ROC analysis identified optimal cutoff values of 7.3% for LV GLS and 9.0% for LASr. Patients with concomitant marked impairment of both strain parameters exhibited the highest mortality risk, whereas those with the least impaired ventricular and atrial strain had the most favorable outcomes. Patients with pronounced impairment of either parameter alone demonstrated intermediate survival. CONCLUSION: In patients hospitalized with HFrEF, both LV GLS and LASr were independently associated with all-cause mortality. Their combined assessment may identify distinct risk phenotypes and provide enhanced risk stratification beyond either parameter alone.