Aug 2026· Journal of Clinical Medicine· Vol 15, pp. 6167· 0 citations· 36 references
Medicine
TL;DR
Left and right atrial stiffness are both associated with adverse outcome in DCM and add prognostic information to an LV-centred risk model, and their unweighted sum offers a single parsimonious measure.
Abstract
Background: Atrial stiffness can be estimated non-invasively using speckle-tracking echocardiography (STE) and has recently emerged as an outcome predictor. We aimed to assess left atrial (LA) and right atrial (RA) phasic function; the LA stiffness index (LASI), the RA stiffness index (RASI) and their sum; and the biatrial stiffness index (BASI) in dilated cardiomyopathy (DCM), and to test whether combining the two atria adds prognostic information over either index alone. Methods: A total of 121 patients with non-ischaemic DCM in sinus rhythm were followed prospectively for a composite endpoint of all-cause death, non-fatal cardiac arrest, or hospitalisation for heart failure decompensation. LASI was defined as the mitral E/e′ ratio divided by LA reservoir strain, RASI as the tricuspid Et/e′t ratio divided by RA reservoir strain, and BASI as the sum of the two. Cox models were adjusted for NYHA class, LV ejection fraction (LVEF), maximal LA volume (LAVmax) and pulmonary artery systolic pressure (PASP). Results: After 19 ± 11 months, 55 patients reached the endpoint. LA reservoir and contraction strain, all three components of RA strain and all three stiffness indices were significantly impaired in patients with events. All stiffness indices were independent outcome predictors in multivariable Cox regression (HR 2.79 [95% CI, 1.35–5.75], p = 0.006 for LASI, HR 1.84 [95% CI, 1.02–3.29], p = 0.04 for RASI and HR 2.74 [95% CI, 1.36–5.51], p = 0.005 for BASI). BASI showed the greatest increase in risk prediction (Δ likelihood ratio χ2 test = 10.3, p = 0.001) over NYHA class, left ventricular ejection fraction, LA maximal volume and pulmonary artery systolic pressure. BASI showed the highest discrimination (AUC = 0.73); however, it was not significantly better than LASI or RASI alone. Conclusions: Left and right atrial stiffness are both associated with adverse outcome in DCM and add prognostic information to an LV-centred risk model. Their unweighted sum performs at least as well as either component and offers a single parsimonious measure, whose incremental clinical value remains to be established in larger, externally validated cohorts.
PURPOSE
Mitral annular calcification (MAC) is associated with atrial fibrillation and diastolic dysfunction, but its relationship with left atrial (LA) mechanics is poorly defined. The ratio of E/e' to LA reservoir strain (LASr) is a non-invasive surrogate of, not a direct measure of, LA stiffness. We assessed MAC and its severity against LASr and this LA stiffness index (LASI).
METHODS
In this single-center cross-sectional study with prospective recruitment, 112 adults in sinus rhythm with ejection fraction ≥50% (58 with MAC, 54 age- and sex-similar controls) underwent two-dimensional speckle-tracking echocardiography. MAC was graded mild to severe; LASI was calculated as E/e' divided by LASr.
RESULTS
LASr was lower (23.2 ± 7.8% vs. 26.7 ± 7.7%, p = 0.018) and LASI higher (0.57 ± 0.30 vs. 0.34 ± 0.20, p < 0.001) in the MAC group. In models excluding the index components, MAC severity was independently associated with higher LASI (β = 0.41, p < 0.001) and MAC presence with lower LASr (-3.6 points, p = 0.016). After clinical adjustment, each 0.1-unit LASI increase was associated with MAC (odds ratio 1.71, 95% CI[1.34-2.17]). LASI discriminated MAC with an area under the curve of 0.762 (0.674-0.851; cut-off 0.31, sensitivity 79%, specificity 63%), which did not differ from E/e' (p = 0.52) or LA volume index (p = 0.48).
CONCLUSION
MAC and its severity were associated with impaired LA reservoir function and a higher non-invasive stiffness index. The index did not discriminate MAC better than its simpler components, so these cross-sectional findings are hypothesis-generating.
Muhammed Ali Şahin, Özdemir Kuzucu, Mustafa Ozan Gürsoy· Echocardiography· 0 citations
BACKGROUND
Left atrial (LA) remodeling represents an integral marker of cardiac damage in aortic stenosis (AS). While the LA volume index (LAVi) reflects chronic pressure overload, left atrial reservoir strain (LARS) by speckle-tracking echocardiography detects early LA dysfunction.
OBJECTIVES
To evaluate the prognostic value of LAVi and LARS in AS, define optimal cut-offs associated with adverse outcomes, and assess whether sex-specific thresholds enhance risk stratification.
METHODS
Retrospective analysis of 552 outpatients (50.4% men, mean age 81±8 years) with at least moderate AS and in sinus rhythm. The composite endpoint was all-cause mortality or hospitalization for heart failure (HHF). Optimal cut-offs for LAVi and LARS were derived using 2-year time-dependent ROC analysis and validated in an independent external cohort of 192 patients (46% men). Associations with outcomes were examined using multivariable Cox regression adjusted for age, NYHA class, and LVEF.
RESULTS
Over a median follow-up of 17.4 months, 118 patients (21.1%) experienced the composite endpoint. In univariable analyses, both larger LAVi and lower LARS were associated with adverse outcomes (both p<0.001). However, only LARS retained prognostic significance after multivariable adjustment. Sex-specific analyses identified LARS<13% in women and <19% in men as the optimal thresholds discriminating higher risk. In multivariable Cox models, reduced sex-specific LARS remained independently associated with adverse outcomes in both sexes (women: HR 1.82 [95% CI 1.04-3.18], p=0.03; men: HR 1.90 [95% CI 1.01-3.60], p=0.045), whereas LAVi lost significance (p≥0.19). These results were consistently reproduced in the external validation cohort (p < 0.05).
CONCLUSIONS
Sex-specific LARS thresholds independently predict mortality and HHF in AS, outperforming LAVi and universal cut-offs. Incorporating LA strain assessment into AS risk stratification may enhance prognostic precision and support personalized management across sexes.
P. Springhetti, Giovanni Benfari, M. Tomaselli et al.· Journal of the American Soci...· 0 citations
RACI is a novel parameter that effectively integrates RA and RV remodeling, and independently predicts all-cause mortality in functional TR, and incorporating RACI into clinical assessment may help with improving risk stratification and guiding the timing of intervention in patients with functional TR.
Robert S. Zhang, G. Falco, E. Li et al.· Circulation Cardiovascular I...· 0 citations
INTRODUCTION
Diagnosing heart failure with preserved ejection fraction (HFpEF) remains challenging in patients with exertional dyspnea and inconclusive resting echocardiography. The left atrial stiffness index (LASI), calculated as E/e' divided by left atrial reservoir strain (LARS), reflects the relationship between estimated left ventricular filling pressure and left atrial compliance.
OBJECTIVES
We aimed to evaluate the performance of the LASI for predicting a positive diastolic stress test (DST) response, its incremental value beyond the HFA-PEFF algorithm, and its potential role as a resting pre-test triage tool within the intermediate HFA-PEFF group.
METHODS
We retrospectively analyzed 376 patients in a derivation cohort and 141 patients in an external validation cohort who underwent noninvasive DST at two tertiary referral centers. Patients with baseline septal E/e' ≥15 were excluded. A positive DST was defined as exercise septal E/e' ≥15, a guideline-based surrogate of exercise-induced elevation in LV filling pressure. Machine-learning models ranked predictors of a positive DST, followed by logistic regression and receiver operating characteristic analysis; the LASI was then examined within the intermediate HFA-PEFF group.
RESULTS
Positive DST occurred in 49 patients (13.0%) in the derivation cohort and 25 patients (17.7%) in the external validation cohort. LASI ranked among the stronger variables associated with positive DST and remained independently associated with positive DST after multivariable adjustment (adjusted odds ratio per 1 SD, 1.81 in the derivation cohort and 1.96 in the validation cohort). At the study-defined cutoff of 0.333, LASI showed high sensitivity and negative predictive value for positive DST in both cohorts (derivation, 80% and 96%; validation, 84% and 94%), although specificity was modest. Within the intermediate HFA-PEFF group, the LASI cutoff separated patients into higher- and lower-yield strata, with only 5% of patients below the cutoff having a positive DST.
CONCLUSION
LASI is a resting echocardiographic marker associated with positive DST and may help refine pre-test selection for DST among patients with suspected HFpEF, particularly those with intermediate HFA-PEFF scores. Rather than serving as a stand-alone diagnostic gatekeeper, LASI may serve as a rule-out triage aid to refine selection for DST.
Minkwan Kim, J. Seo, S. Bae et al.· Journal of the American Soci...· 0 citations
BACKGROUND
The assessment of stable coronary artery disease has been performed using the first-phase ejection fraction (EF1) in previous research. However, the use of EF1 has seldom been employed in the evaluation of early left ventricular systolic dysfunction among patients with hypertrophic cardiomyopathy (HCM).
OBJECTIVE
We aimed to assess early left ventricular systolic dysfunction in patients with HCM by application of first-phase EF1.
METHODS
The cohort included 90 HCM patients who were stratified according to pathophysiological subtype into 50 with nonobstructive (NO-HOCM) and 40 with obstructive (HOCM) disease. An additional 50 age-matched healthy individuals served as controls. Baseline characteristics, conventional echocardiographic parameters, EF1 were measured and serum B-type natriuretic (BNP) peptide was detected. Additionally, the correlations between EF1 and both LVMI and BNP were compared, and receiver operating characteristic (ROC) curve analysis was performed to calculate the area under the curve (AUC) for assessing the value of EF1 in the early detection of left ventricular systolic dysfunction in HCM patients.
RESULTS
Compared to the control group, patients with HOCM showed higher systolic blood pressure and lower heart rate (p < 0.05). Both HOCM and NO-HCM showed enlarged LAD and LVDd, elevated LVMI, LVEF, E/e' ratios and BNP compared with controls (p < 0.05). However, EF1 was decreased in HCM patients than that in controls (38.20 ± 2.02, P < 0.05), especially in HOCM patients (22.29 ± 3.59 & 25.12 ± 3.19, P < 0 .05). EF1 was negatively correlated with both LVMI and BNP (all r > 0.3, P < 0.001). Receiver operating characteristic (ROC) curve analysis demonstrated that EF 1 (AUC = 0.874) exhibited superior diagnostic value for assessing early left ventricular systolic dysfunction in patients with HCM compared with LVEF (AUC = 0.649). The optimal cut-off value for EF1 was < 28.5%, with a sensitivity of 90.6% and a specificity of 81.5%, corresponding to an AUC of 0.874 (95% CI: 0.804-0.946, p < 0.001).
CONCLUSION
Compared with healthy controls, patients with HCM had a lower EF1, and this reduction was significantly more pronounced in those with HOCM. Given its high sensitivity in evaluating left ventricular systolic function in patients with HCM, EF1 represents a promising adjunctive parameter for the multimodal assessment of systolic function in this population.
With aging societies, heart failure (HF) is a growing public health concern, particularly HF with a preserved left ventricular ejection fraction (HFpEF). Patients with atherosclerotic cardiovascular disease (ASCVD) are at an increased risk of incident HF, while the prediction of individual risk remains challenging. Speckle-tracking echocardiography enables an objective and quantitative assessment of subtle myocardial alterations that are undetectable with conventional echocardiography and has excellent feasibility and reproducibility. Left ventricular global longitudinal strain (LVGLS), a sensitive measure of LV systolic dysfunction, has been found to be an independent risk factor for the occurrence of HF. In addition, more than 50% of patients with HFpEF had impaired LVGLS. Recently, deformation imaging has been employed to assess left atrial (LA) performance, and impaired LA strain has been shown to predict unfavorable outcomes in various clinical settings. This review article presents the clinical relevance of subclinical left heart dysfunction in patients with ASCVD and describes its future perspectives.
K. Nakanishi· Journal of atherosclerosis a...· 0 citations