Background. Two-dimensional speckle tracking (2D-ST) analysis allows to evaluate both atrial and ventricular function. Recently, it has been demonstrated that the ratio between left atrial reservoir (LAr) assessed by 2D-ST and the E/e’ ratio could allow a more accurate estimation of left ventricular filling pressure.
Aim of the study. To evaluate if the ratio between LAr and E/e’ is also associated with heart failure progression among chronic heart failure (CHF) outpatients.
Methods. All patients enrolled underwent a medical visit, an ECG and an echocardiographic examination. LAr was assessed by 2D-ST. The early diastolic peak at pulsed Doppler (E) and at the level of septal (e’s) and lateral (e’l) mitral annulus by Tissue Doppler Imaging (TDI) were also evaluated. Then the ratio between E and e’s (E/es) and between E and the mean of e’s and e’l (E/em) were also calculated. Finally, the ratio between LAr and E/es (LAr/Ees) and E/em (LAr/Eem) were computed. During follow-up the progression of heart failure, defined as heart failure hospitalization or death, were evaluated.
Results. Among 256 patients, LAr/Eem and LA/Ees were available in 191 patients (age 64±13 years,80 % males, mean LVEF 39±11%, NYHA class 2.3±0.5). All patients were in conventional medical therapy (sacubitril/valsartan or ACE-inhibitors or Angiotensin II receptor blockers in 85%, beta-blockers in 94%, mineralcorticoid receptor antagonists in 73%, diuretics in 81%, SGLT2 inhibitors in 21%). During a mean follow-up of 13±7 months, 25 patients experienced death (9) and/or hospitalization (21) for heart failure worsening.
At univariate Cox univariate regression analysis, both LAr/Eem (HR 0.61; 95%CI: 0.43-0.87; p:0.006) and LAr/Ees (HR 0.43; 95%CI: 0.25-0.71; p:0.001) were associated with the events. However, LAr/Ees showed a greater accuracy than LAr/Eem (C-index 0.76 vs. 0.73) and remained significantly associated with the events at multivariate analysis after correction for age, LVEF, NYHA class and estimated glomerular filtration rate (HR: 0.55; 95%CI: 0.33-0.92; p:0.22).
Figure shows Kaplan-Meier curves according with the median value of LAr/Eem (panel A) and LAr/Ees (panel B).
Conclusions. The ratio between LAr and E/es is a new echocardiographic parameter able to reflect both left ventricular filling pressure and worse prognosis among patients affected by CHF. Further studies should evaluate its incremental value in stratifying patients’ prognosis.