Ricken Kim W L M, Lenselink Chris, Venema Constantijn S, van der Horst Iwan C C, van der Harst Pim, Pundziute-Do Prado Gabija, Voors Adriaan A, Lipsic Erik
Department of Cardiology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands.
Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; Cardiovascular Research Institute (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands.
Int J Cardiol. 2025 Mar 1;422:132931. doi: 10.1016/j.ijcard.2024.132931. Epub 2024 Dec 22.
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).
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).
The LA reservoir strain has incremental value in the prediction of long-term heart failure outcomes in patients after a first STEMI.
左心房（LA）应变不仅反映左心房功能，还反映左心室的收缩和舒张功能。因此，我们假设LA应变可能是ST段抬高型心肌梗死（STEMI）后心力衰竭相关终点的综合预测指标。我们旨在评估LA储备应变对ST段抬高型心肌梗死（STEMI）后长期预后的影响。
在287例首次发生STEMI的患者住院期间，使用二维斑点追踪超声心动图测量LA应变。根据LA储备应变的四分位数对患者进行分类，以分析人群特征并评估无事件生存期。使用Cox回归确定心脏死亡、心力衰竭住院和新发心力衰竭这一复合心力衰竭终点的预测因素。研究人群的年龄为57.8±11.3岁，男性占主导（74.6%）。中位随访8.8年后，33例（11.5%）患者达到复合终点。LA储备应变的平均值为27.5±7.97%。LA储备应变较低的患者年龄较大（p = 0.003），入院时左心室射血分数（LVEF）较低（p < 0.001）。复合终点的独立预测因素为年龄较大（HR = 1.07，p = 0.001）、LVEF较低（HR = 0.94，p = 0.015）、舒张压较低（HR = 0.97，p = 0.034）和LA储备应变较低（HR = 0.90，p = 0.003）。将LA储备应变添加到临床风险预测模型中可显著改善其性能（C统计量0.838对0.784，p = 0.003）。
LA储备应变在预测首次STEMI后患者的长期心力衰竭结局方面具有增量价值。
