Difference in Prognostic Value of Left Atrial Longitudinal and Circumferential Strain

Background: Left ventricular longitudinal strain (LVLS), Left atrial (LA) volume and functional indices measured by two dimensional echocardiography (2DE) have significant prognostic value for major cardiovascular events (MACE: cardiac death, stroke, nonfatal myocardial infarction and hospitalization for heart failure). Prognostic values of left atrial longitudinal and circumferential strain measured by three-dimensional speckle tracking analysis (3DSTA) were evaluated. Method: Two hundred eight patients (Male 61%, 65 ± 15yo) with various kind of cardiovascular diseases underwent standard 2DE and 3DSTA of left atrium. Maximum and minimum left atrial volume (LAVImax and LAVImin), left atrial emptying fraction (LAEmpF), peak global LA area strain (LAAS), circumferential strain (LACS) and longitudinal strain (LALS) were measured using 3DSTA. Serial changes of LACS and LALS were also recorded in 14 patietns hospitalized with heart failure. Results: During a mean follow-up of 611 ± 371 days, MACE developed in 23 patients. By multivariate analysis, CAD, CKD, 2DLVLS, 2DLAVImax, 2DLAmin and all LA indices were significant independent factors predicting MACE. The model added LALS or LAEmpF by 3DSTA had higher prognostic value (LALS <10.4%, AUC; 0.88, HR;7.45 CI:2.62–24.34, LAEmpF <2.7%: AUC; 0.88, HR:9.05, CI:2.93–37.53) than LACS. In patients with HF, LACS showed more rapid and greater change after therapy than LALS (rate of change: 108% vs 64%, P < .01). Conclusion: LALS is more robst predictor of future MACE than LACS.