Left atrial strain predicts long-term heart failure outcomes after ST-elevation myocardial infarction

Abstract

Background: Left atrial (LA) strain reflects not only LA function but also systolic and diastolic left ventricular function. We therefore hypothesize that LA strain may be a comprehensive predictor of heart failure related endpoints after ST-elevation myocardial infarction (STEMI). We aim to assess the impact of LA reservoir strain on the long-term prognosis following ST-elevation myocardial infarction (STEMI). Method and results: LA strain was measured in 287 first-time STEMI patients using two-dimensional speckle tracking echocardiography at hospitalization. Patients were categorized according to quartiles of LA reservoir strain for the analysis of population characteristics and assessment of event-free survival. Predictors of the composite heart failure endpoint of cardiac death, heart failure hospitalization, and new-onset heart failure were identified using Cox regression. The study population was 57.8 ± 11.3 years of age and predominantly male (74.6 %). After a median follow-up of 8.8 years, 33 (11.5 %) patients reached the composite endpoint. Mean LA reservoir strain was 27.5 ± 7.97 %. Patients with lower LA reservoir strain were older (p = 0.003) and had a lower left ventricular ejection fraction (LVEF, p < 0.001) at admission. Independent predictors for the composite endpoint were higher age (HR = 1.07, p = 0.001), lower LVEF (HR = 0.94, p = 0.015), lower diastolic blood pressure (HR = 0.97, p = 0.034), and lower LA reservoir strain (HR = 0.90, p = 0.003). Adding LA reservoir strain to a clinical risk prediction model significantly improved its performance (C-statistic 0.838 vs. 0.784, p = 0.003). Conclusion: The LA reservoir strain has incremental value in the prediction of long-term heart failure outcomes in patients after a first STEMI.