Heart failure (HF) is a major cause of death, and it has a poor prognosis despite the significant reduction in mortality achieved in clinical trials. Left atrial (LA) function represents powerful outcome predictor in patients with HF, because closely related to left ventricular diastolic dysfunction. Two-dimensional speckle tracking (2DST) is an echocardiographic tool that enable the quantification of longitudinal myocardial LA deformation dynamics.
The purpose of the present study was to evaluate the usefulness of 2DST analysis of LA function to predict cardiovascular outcomes in outpatients affected by chronic HF with reduced ejection fraction implanted with cardiac resynchronization device (CRT).
We prospectively enrolled consecutive outpatients with chronic HF and previous CRT implantation. Transthoracic echocardiography was performed at the basal visit: left ventricular volumes, left atrial volumes and peak atrial longitudinal strain (global PALS) were measured. The development of MACE (major adverse cardiovascular events) during follow up was evaluated as a composite endpoint defined as congestive HF + nonfatal myocardial infarction + stroke + cardiovascular mortality.
146 patients (mean age 67±11, 81% male) met eligibility criteria. Almost all patients presented LA dilation and LA difunction. During a median follow-up of 48±11 months MACE occurred in 61 (42%) patients.
In a multivariable model global PALS [HR: 0.97 (95% CI: 0.94 – 0.99), p =0.04], left ventricular ejection fraction [HR: 0.94 (95% CI: 0.91 – 0.97), p<0.01] and renal function [HR: 0.98 (95% CI: 0.98 – 0.99), p =0.01] were independent predictors of an adverse outcome.
Moreover, during follow-up 33 patients (23%) died for cardiovascular events. It was confirmed that global PALS [HR: 0.96 (95% CI: 0.93 – 0.99), p = 0.02], left ventricular ejection fraction [HR: 0.96 (95% CI: 0.93 – 1.00), p = 0.03] and renal function [HR: 0.98 (95% CI: 0.97– 0.99), p < 0.01] were independent predictors of cardiovascular mortality.
In chronic systolic heart failure population treated with CRT, left atrial longitudinal deformation analysis derived from two-dimensional speckle-tracking echocardiography independently correlates with cardiovascular outcome.