Left atrial strain improves prediction of major adverse cardiovascular events in heart failure

Background Left atrial (LA) dysfunction is a key component of heart failure (HF) pathophysiology. Left atrial reservoir strain (LASr), measured by 2D speckle-tracking echocardiography, is a sensitive marker of atrial function, but its prognostic value across all HF phenotypes is not fully established. Purpose To evaluate the prognostic significance of LASr for predicting major adverse cardiovascular events (MACE) in HF patients. Methods We retrospectively included 170 HF patients hospitalized at our tertiary cardiovascular center (Jan–Dec 2023), followed for a median of 26 months. LASr, standard echocardiographic, demographic, and laboratory parameters were recorded. Primary endpoint was MACE, defined as a composite of cardiovascular death and HF rehospitalization. Univariable and multivariable logistic regression assessed prognostic value. Results Patients were 68% male, median age 70 years. Median LASr was 18% (IQR 12–24). LASr was significantly associated with MACE (OR 0.868, 95% CI 0.825–0.914, p<0.01), cardiovascular death (OR 0.902, 95% CI 0.846–0.962, p=0.02), and HF rehospitalization (OR 0.902, 95% CI 0.858–0.948, p<0.01). In multivariable analysis, LASr remained an independent predictor of MACE (OR 0.874, 95% CI 0.770–0.992, p=0.04). ROC analysis showed superior discriminative ability of LASr (AUC 0.758) versus E/e′ ratio (AUC 0.752), left atrial volume index (AUC 0.679), and left ventricular ejection fraction (LVEF) (AUC 0.570). Conclusion(s) LASr is an independent predictor of adverse cardiovascular outcomes in HF patients, regardless of LVEF. Incorporating LASr into routine echocardiography may improve risk stratification in this population.