Left atrial strain in chronic coronary syndrome with heart failure with preserved ejection fraction
R V Shamoyan, A L Chilingaryan, L G Tunyan, H G HayrapetyanAbstract
Background
Chronic coronary syndrome(CCS) is a common and impactful contributor to heart failure with preserved ejection fraction(HFpEF). Multiple studies have shown that HFpEF patients with established CCS have worse outcomes than those without. Recent studies indicate that both left atrial reservoir strain(LASr) and pump strain(LASp) are related to left ventricular(LV) mechanical function.
Purpose
We sought to determine the role of LA strain parameters in the management of HFpEF in patients with documented CCS.
Methods
We examined 94 patients(50 males and 44 females, mean age 56±9 years) with co-occurring CCS and HFpEF. All study patients had a prior diagnosis of HFpEF with CCS for at least one year. Clinical assessments performed at the clinic included standard 12-lead electrocardiography, routine blood tests, and transthoracic echocardiography using GE Vivid E95 equipment, specifically incorporating LA strain. According to the LA strain parameters, all patients were divided into two groups: Group A: LASr<20% and LASp< 8%, Group B: LASr≥20% and/or LASp≥8%.
Results
The study investigated whether specific LA strain parameters could predict acute cardiovascular events(ACVEs) over a one-year follow-up period. The primary endpoint of the study was the occurrence of ACVEs at the one-year mark. The study population was divided into two groups of 47 patients each: Group A: LASr<20% and LASp<8%(see figure 1), Group B: Patients with LASr≥20% and/or LASp≥8%. The results demonstrated a statistically significant difference in the incidence of ACVEs between the two groups. Within Group A, 18 out of 47 patients(38.3%) experienced an ACVE within one year. In contrast, only 7 out of 47 patients(14.9%) in Group B experienced an event(see table 1). The difference between these two groups was statistically significant, p<0.02.
Conclusion
Reduced LASr and LASp are significantly associated with a higher incidence of new ACVEs in patients with concurrent CCS and HFpEF. Further prospective validation is required to establish the diagnostic accuracy and clinical utility of these strain parameters as prognostic markers.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.