Prognostic value of left atrial reservoir strain in stroke center

Abstract

Introduction

Left atrium (LA) is a key determinant of left ventricular filling and cardiac performance. The LA reservoir strain affects prognosis in patients with heart failure. Little is known about prognostic value of LA reservoir strain after ischemic stroke.

Objective

To evaluate the prognostic value of the LA reservoir strain in patients after ischemic stroke, in term of MACE (major adverse cardiovascular events) and mortality.

Method

We included retrospectively patients admitted in the Echo Lab of the neurovascular unit of Raymond Poincare Hospital (Garches) because of ischemic stroke or transient ischemic attack and who experienced a measurement of the LA reservoir strain using 2D speckle tracking imaging. We excluded patients with atrial fibrillation (AF).

Results

We included 318 patients (median age 69.5 years) (80%, ischemic stroke). Systemic hypertension and diabetes were present respectively in 65% and 23% of patients. The median Nt pro BNP was at 170 ng/L [70–549]. The median LA reservoir strain was at 17% [10–25]. The median values of the other echocardiographic parameters were: left ventricular ejection fraction (LVEF) at 60% [58–67], mitral lateral ratio E/Ea at 9 [6–12], LA volume indexed at 38 mL/m² [28-46], median tricuspid annular plane systolic excursion (TAPSE) at 18 mm [16–21] and median systolic arterial pulmonary pressure (sPAP) at 32 mmHg [27–38]. After a median 2 years and 3 months follow- up, MACE occurred in 41 patients (13%) and death in 22 patients (7%). Using a Cox model, a LA reservoir strain < 17% was associated with the onset of MACE (HR 2.2, P < 0.016) (Figure 1Graph 1) and mortality (HR 2.8, P 0.032).

Conclusion

The LA reservoir strain may be used as a prognostic biomarker in stroke center.