Predictors of left atrial strain recovery in patients hospitalized with acute heart failure with reduced ejection fraction
Öz
Aims: Left atrial (LA) function is crucial in heart failure (HF) pathophysiology, and its impairment is associated with adverse outcomes. LA reservoir strain (LASr), assessed via speckle-tracking echocardiography, has emerged as a sensitive marker of LA mechanics, yet its recovery during acute HF remains unclear. This study aimed to identify the clinical and echocardiographic predictors of LASr improvement in patients hospitalized with acute decompensated HF with reduced ejection fraction (HFrEF).
Methods: This retrospective study included 63 hospitalized patients with acute decompensated HFrEF (LVEF <40%). Patients were classified into improvers (≥15% increase in LASr) and non-improvers based on LASr recovery during hospitalization. Clinical and echocardiographic parameters were compared between groups, and independent predictors of LASr improvement were identified through logistic regression analysis. Model performance was evaluated using ROC and decision curve analyses.
Results: LASr improved in 38% of patients (improvers: n=24), increasing from 7.8% (IQR: 4.8–11.5) to 10.0% (IQR: 7.0–13.0, p=0.035). Compared to non-improvers, improvers had higher LVEF (p=0.009), smaller LV end-diastolic diameter (p=0.015), and lower prevalence of moderate-to-severe mitral regurgitation (p=0.012). In multivariate analysis, LVEF (OR: 1.204, 95% CI: 1.040–1.395) and LV end-diastolic diameter (OR: 0.879, 95% CI: 0.780–0.990) predicted LASr recovery, while moderate-to severe MR was associated with lower recovery (OR: 0.170, 95% CI: 0.029–0.988). ROC analysis confirmed model performance (AUC: LVEF 0.852, EDD 0.831, MR 0.779).
Conclusion: LASr improvement during hospitalization is closely linked to baseline LV function, ventricular dimensions, and MR severity, highlighting its dynamic nature in acute HF and potential as a marker of cardiac recovery.
Anahtar Kelimeler
Left atrial reservoir strain heart failure with reduced ejection fraction acute heart failure strain recovery echocardiographic assessment
Etik Beyan
The study was initiated with the approval of the Başakşehir Çam ve Sakura City Hospital Clinical Research Ethics Committee (Date: 2022, Decision No: 135).
Destekleyen Kurum
None
Teşekkür
None
Kaynakça
- Kupczyńska K, Mandoli GE, Cameli M, Kasprzak JD. Left atrial strain-a current clinical perspective. Kardiol Pol. 2021;79(9):955-964. doi:10. 33963/KP.A2021.0105
- Katogiannis K, Makavos G, Tsilivarakis D, et al. Left atrial deformation in heart failure: a clinical update. Curr Probl Cardiol. 2023;48(8):101183. doi:10.1016/J.CPCARDIOL.2022.101183
- Park JH, Hwang IC, Park JJ, Park JB, Cho GY. Prognostic power of left atrial strain in patients with acute heart failure. Eur Heart J Cardiovasc Imaging. 2021;22(2):210-219. doi:10.1093/ehjci/jeaa013
- Deferm S, Martens P, Verbrugge FH, et al. LA mechanics in decompensated heart failure: insights from strain echocardiography with invasive hemodynamics. JACC Cardiovasc Imaging. 2020;13(5):1107-1115. doi:10.1016/j.jcmg.2019.12.008
- Gillebert TC, Smiseth OA. Left atrial reservoir strain in prognosis of heart failure and time for getting terminology straight. Eur Heart J Cardiovasc Imaging. 2024;25(3):325-327. doi:10.1093/EHJCI/JEAD311
- McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599-3726. doi:10.1093/EURHEARTJ/EHAB368
- Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the american society of echocardiography and the european association of cardiovascular imaging. Eur Heart J Cardiovasc Imaging. 2015; 16(3): 233-271. doi:10.1093/EHJCI/JEV014
- Lancellotti P, Tribouilloy C, Hagendorff A, et al. Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of cardiovascular imaging. Eur Heart J Cardiovasc Imaging. 2013;14(7):611-644. doi:10. 1093/ehjci/jet105
- Voigt JU, Pedrizzetti G, Lysyansky P, et al. Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging. 2015;16(1):1-11. doi:10.1093/EHJCI/JEU184
- Pio SM, Medvedofsky D, Delgado V, et al. Left atrial improvement in patients with secondary mitral regurgitation and heart failure: the COAPT trial. JACC Cardiovasc Imaging. 2024;17(9):1015-1027. doi:10. 1016/J.JCMG.2024.03.016
- Inoue K, Khan FH, Remme EW, et al. Determinants of left atrial reservoir and pump strain and use of atrial strain for evaluation of left ventricular filling pressure. Eur Heart J Cardiovasc Imaging. 2021;23(1):61-70. doi: 10.1093/EHJCI/JEAA415
- Hoit BD. Left atrial reservoir strain: its time has come. JACC Cardiovasc Imaging. 2022;15(3):392-394. doi:10.1016/J.JCMG.2021.10.003
- Barki M, Losito M, Caracciolo MM, et al. Left atrial strain in acute heart failure: clinical and prognostic insights. Eur Heart J Cardiovasc Imaging. 2024;25(3):315-324. doi:10.1093/EHJCI/JEAD287
- Sun Y, Chen X, Zhang Y, et al. Reverse atrial remodeling in heart failure with recovered ejection fraction. J Am Heart Assoc. 2023;12(2):e026891. doi:10.1161/JAHA.122.026891
- Stassen J, Namazi F, van der Bijl P, et al. Left atrial reservoir function and outcomes in secondary mitral regurgitation. J Am Soc Echocardiogr. 2022;35(5):477-85.e3. doi:10.1016/j.echo.2022.01.007
- Hullin R, Tzimas G, Barras N, et al. Decongestion improving right heart function ameliorates prognosis after an acute heart failure episode. ESC Heart Fail. 2022;9(6):3814. doi:10.1002/EHF2.14077
Öz
Kaynakça
- Kupczyńska K, Mandoli GE, Cameli M, Kasprzak JD. Left atrial strain-a current clinical perspective. Kardiol Pol. 2021;79(9):955-964. doi:10. 33963/KP.A2021.0105
- Katogiannis K, Makavos G, Tsilivarakis D, et al. Left atrial deformation in heart failure: a clinical update. Curr Probl Cardiol. 2023;48(8):101183. doi:10.1016/J.CPCARDIOL.2022.101183
- Park JH, Hwang IC, Park JJ, Park JB, Cho GY. Prognostic power of left atrial strain in patients with acute heart failure. Eur Heart J Cardiovasc Imaging. 2021;22(2):210-219. doi:10.1093/ehjci/jeaa013
- Deferm S, Martens P, Verbrugge FH, et al. LA mechanics in decompensated heart failure: insights from strain echocardiography with invasive hemodynamics. JACC Cardiovasc Imaging. 2020;13(5):1107-1115. doi:10.1016/j.jcmg.2019.12.008
- Gillebert TC, Smiseth OA. Left atrial reservoir strain in prognosis of heart failure and time for getting terminology straight. Eur Heart J Cardiovasc Imaging. 2024;25(3):325-327. doi:10.1093/EHJCI/JEAD311
- McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599-3726. doi:10.1093/EURHEARTJ/EHAB368
- Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the american society of echocardiography and the european association of cardiovascular imaging. Eur Heart J Cardiovasc Imaging. 2015; 16(3): 233-271. doi:10.1093/EHJCI/JEV014
- Lancellotti P, Tribouilloy C, Hagendorff A, et al. Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of cardiovascular imaging. Eur Heart J Cardiovasc Imaging. 2013;14(7):611-644. doi:10. 1093/ehjci/jet105
- Voigt JU, Pedrizzetti G, Lysyansky P, et al. Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging. 2015;16(1):1-11. doi:10.1093/EHJCI/JEU184
- Pio SM, Medvedofsky D, Delgado V, et al. Left atrial improvement in patients with secondary mitral regurgitation and heart failure: the COAPT trial. JACC Cardiovasc Imaging. 2024;17(9):1015-1027. doi:10. 1016/J.JCMG.2024.03.016
- Inoue K, Khan FH, Remme EW, et al. Determinants of left atrial reservoir and pump strain and use of atrial strain for evaluation of left ventricular filling pressure. Eur Heart J Cardiovasc Imaging. 2021;23(1):61-70. doi: 10.1093/EHJCI/JEAA415
- Hoit BD. Left atrial reservoir strain: its time has come. JACC Cardiovasc Imaging. 2022;15(3):392-394. doi:10.1016/J.JCMG.2021.10.003
- Barki M, Losito M, Caracciolo MM, et al. Left atrial strain in acute heart failure: clinical and prognostic insights. Eur Heart J Cardiovasc Imaging. 2024;25(3):315-324. doi:10.1093/EHJCI/JEAD287
- Sun Y, Chen X, Zhang Y, et al. Reverse atrial remodeling in heart failure with recovered ejection fraction. J Am Heart Assoc. 2023;12(2):e026891. doi:10.1161/JAHA.122.026891
- Stassen J, Namazi F, van der Bijl P, et al. Left atrial reservoir function and outcomes in secondary mitral regurgitation. J Am Soc Echocardiogr. 2022;35(5):477-85.e3. doi:10.1016/j.echo.2022.01.007
- Hullin R, Tzimas G, Barras N, et al. Decongestion improving right heart function ameliorates prognosis after an acute heart failure episode. ESC Heart Fail. 2022;9(6):3814. doi:10.1002/EHF2.14077
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Kardiyoloji |
| Bölüm | Research Articles |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Mayıs 2025 |
| Gönderilme Tarihi | 1 Mart 2025 |
| Kabul Tarihi | 4 Nisan 2025 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 7 Sayı: 3 |
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