Peak atrial longitudinal strain is associated with in-hospital mortality in patients with acute or descompensated heart failure
Authors: Beltran Ontiveros LD , Tobias Morales AK , Ortiz Leon XA , Fritche-Salazar JF , Posada Martinez L , De La Fuente Mancera JC , Jalife Velazquez GQ , Torres Machorro A , Ruiz Esparza ME , Arias Godinez JA , Rodriguez Zanella H 
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background. Acute heart failure (AHF) either new onset, or more commonly acute descompensated chronic heart failure is the leading cause of hospitalization in patients &gt;65 years old worldwide. AHF carries increased risk of morbidity and mortality. [1] Therefore prognostic factors are of interest to improve risk stratification and to identify patients in need of more aggresive treatment. [2]

Different echocardiographic parameters, such as cardiac chambers dimensions, diastolic function, left ventricular ejection fraction (LVEF), and global longitudinal strain (GLS) have shown to predict worse outcome. [3]

Peak Atrial Longitudinal Strain (PALS), which reflect the reservoir function has gained interest and semi automatic tools are now available its quantification. [4] Furthermore PALS has shown to have incremental value in different cardiac diseases. [5] However the role of PALS in patients with AHF has not been thoroughly studied and remains of interest.

Objetive. We aimed to evaluate the association of PALS with in-hospital mortality in patients with AHF.

Material and Methods. A prospective single center study was performed in patients admitted to the emergency department with AHF according to the criteria of current European guidelines. Clinical and biochemical data were collected, and echocardiography with quantification of left ventricular, right ventricular and left atrial deformation, was performed during the first 24 hours of admission. Patients were followed up during hospitalization. PALS was quantified by a single vendor semi automatic software averaging values from the 4-chamber and 2-chamber views. The primary outcome was in-hospital mortality. Variables were compared between patients with and without the outcome. A ROC curve was performed to define the best cut-off point, sensitivity and specificity of PALS. Logistic regression analysis (LRA) was performed to assess the association of PALS and mortality.

Results. Fifty-seven patients were included. Aged 59 (51-66) years. Twenty-four percent were women, NTproBNP 5204 (1273-11546), LVEF 35 ± 14%. The average length of stay was 8 (4-18) days. A total of 5 (8%) patients died during their stay, 4 due to cardiogenic shock and one due to ventricular tachycardia. Patients who died had lower PALS compared to patients who survived (8.7 ± 3.3 vs 19 ± 10.3; p &lt; 0.001). In the ROC curve analysis an atrial strain value of less than 10% had a sensitivity of 77% and specificity of 80% to identify mortality AUC 0.77 (0.65-0.89) p = 0.45. Interestingly, LVEF (p = 0.117), GLS (p = 0.234) and RV free wall strain (p = 0.549) were not different among groups. LRA showed a tendency of PALS to be associated with mortality [(OR 0.869 (CI 0.752-1.004); p = 0.057)].

Conclusions. Patient with AHF who died had lower PALS compared to those who survived. A value of less than 10% may identify patients with a higher risk of mortality. Larger studies to define the prognostic value of PALS in patients with AHF are needed. Abstract Figure. Graphic representing PALS cut-off point  Abstract Figure. Representative image of PALS