Left Atrial Strain Determinants and Clinical Features According to the Heart Failure Stages. New Insight from EACVI MASCOT Registry

Background: Few studies analyzed left atrial (LA) peak atrial longitudinal strain (PALS) determinants, particularly across heart failure (HF) stages. Objective: We aimed to analyze the pathophysiological and clinical PALS correlates in a large multicentric prospective study. Methods: : This is a multicenter prospective observational study enrolling 745 patients with HF stages. Data included PALS and left ventricular global longitudinal strain (LV-GLS). Exclusion criteria were: valvular prosthesis; atrial fibrillation; cardiac transplantation; poor acoustic window. Results: : Median global PALS was 17% [24-32]. 29% of patients were in HF-stage 0-A, 35% in stage-B, and 36% in stage-C. Together with age, the echocardiographic determinants of PALS were LA volume and LV-GLS (overall model R²=0.50, p<0.0001). LV-GLS had the strongest association with PALS at multivariable analysis (beta:-3.60±0.20, p<0.0001). Among HF stages, LV-GLS remained the most important PALS predictor (p<0.0001) whereas age was only associated with PALS in lower HF-stage 0-A or B (R=-0.26 p<0.0001, R=-0.23 p=0.0001). LA volume increased its association to PALS moving from stage 0-A (R=-0.11; P=0.1) to C (R=-0.42; P<0.0001). PALS was the single most potent echocardiographic parameter in predicting the HF stage (AUC for B vs. 0-A 0.81, and AUC vs. 0-A for C 0.76). PALS remained independently associated with HF stages after adjusting for ejection fraction, E/e’ ratio, and mitral regurgitation grade (p<0.0001). Conclusions: : Although influenced by LV-GLS and LA size across HF stages, PALS is incrementally and independently associated with clinical status. LA function may reflect a substantial part of the hemodynamic consequences of ventricular dysfunction.