Lower left atrial reservoir strain was associated with increased risk of death and rehospitalization (HR 0.93 per 1% decrease), and lower global longitudinal strain was associated with higher mortality risk (HR 0.94 per 1% decrease) in patients hospitalized for acute heart failure.
Cohort (n=141)
No
Do global longitudinal strain and left atrial strain metrics predict all-cause mortality and heart failure rehospitalization in patients with acute heart failure?
In patients with acute heart failure, impaired left atrial reservoir strain is a robust independent predictor of both all-cause mortality and heart failure rehospitalization.
Effect estimate: HR 0.93 per 1% increase in LAr for mortality; HR 0.93 per 1% increase in LAr for rehospitalization (95% CI 95% CI 0.89–0.98 for mortality; 0.88–0.98 for rehospitalization)
p-value: p=0.009 for mortality; 0.004 for rehospitalization
Abstract Background Global longitudinal strain (GLS) and left atrial strain metrics, including reservoir (LAr), contraction (LAct), and conduit strain (LAcd), have emerged as key indicators of left ventricular (LV) function and filling pressures. However, the prognostic value of these markers for risk stratification in acute heart failure (HF) remains uncertain, particularly in identifying patients at elevated risk of rehospitalization and mortality. Results In the prospective HARVEST cohort study, LA strain and GLS measurements were obtained retrospectively in 141 patients (mean age 71 ± 13, 25% women). Strain values are reported as absolute values reflecting the magnitude of deformation regardless of sign. Multivariable adjusted Cox regression was used to test whether GLS, LAr, LAct, and LAcd were associated with all-cause mortality and HF rehospitalization. Hazard ratios were calculated per 1% decrease in strain values. During a median follow-up time of 39 (IQR 14–66) months (490 patient-years) for mortality analyses and 22 (IQR 4–51) months (354 patient-years) for HF rehospitalization 62 (44%) patients died, and 62 (44%) were rehospitalized. Higher GLS, LAr, and LAcd were associated with a lower risk of mortality (HR:0.94, 95%CI:0.89–0.99, p = 0.045; HR:0.93, 95%CI:0.89–0.98, p = 0.009; and HR:0.94, 95%CI:0.88–0.99, p = 0.039, respectively), and higher LAr and LAct were associated with reduced risk of HF rehospitalization (HR:0.93, 95%CI:0.88–0.98, p = 0.004; and HR:0.85, 95%CI:0.77–0.94, p = 0.002, respectively). Conclusion In patients with acute HF, strain parameters predict prognosis, with poorer outcomes. Notably, decreasing LAr was associated with increased risk of both death and rehospitalization for HF, whereas decreasing GLS was only associated with higher mortality risk.
Zilic et al. (2026) conducted a cohort in Patients hospitalized for acute heart failure with LV ejection fraction ranging from reduced to preserved and mean age 71 years (n=141). Measurement of left ventricular global longitudinal strain (GLS) and left atrial strain parameters (reservoir LAr, contraction LAct, conduit LAcd) vs. No strain measurement was evaluated on All-cause mortality and heart failure rehospitalization (HR 0.93 per 1% increase in LAr for mortality; HR 0.93 per 1% increase in LAr for rehospitalization, 95% CI 95% CI 0.89–0.98 for mortality; 0.88–0.98 for rehospitalization, p=0.009 for mortality; 0.004 for rehospitalization). Lower left atrial reservoir strain was associated with increased risk of death and rehospitalization (HR 0.93 per 1% decrease), and lower global longitudinal strain was associated with higher mortality risk (HR 0.94 per 1% decrease) in patients hospitalized for acute heart failure.