CONGRESS ABSTRACT

Background. Left atrial (LA) function is tightly interrelated with the haemodynamic conditions in patients with heart failure (HF). Optimisation of left ventricular (LV) haemodynamics may improve LA-LV coupling, leading to enhanced cardiac function and reduced LV filling pressures. Methods. Consecutive HF with reduced ejection fraction patients were prospectively enrolled. All patients underwent clinical, biochemical, echocardiographic (basic and advanced), and right heart catheterization (RHC). Patients with pulmonary hypertension were re-evaluated after a reversibility test. Associations between peak left atrial longitudinal strain (PALS) and contraction strain (CTs) with pulmonary artery wedge pressure (PAWP) were investigated by bivariate regression analysis. The composite primary outcome was death/heart transplant/LVAD/HF hospitalization. The results were validated on the same population considering non-invasive PAWP estimation. Results. One-hundred-four patients were enrolled. Mean age was 52±12 years, 33% had a history of atrial fibrillation, and median NTproBNP was 1502 (741–2950) pg/ml. Patients with PALS below the median had higher E/E’ (15 (11–19) vs 10 (8–14), p=0.028) and PAWP (18 (16–22) vs 10 (5–20) mmHg, p=0.003). PALS and CTs showed a significant but modest association with PAWP (r=-0.326, p=0.001 and r=-0.345, p=0.002, respectively). Patients with PALS below the median showed a higher risk of the primary outcome (unadjusted HR 0.430 (0.225–0.823), p=0.011), which was confirmed in multivariable models. In patients undergoing a reversibility test, a general improvement in haemodynamics and LA function was observed. The component of LA strain most associated with changes in PAWP was CTs (r=-0.764, p<0.001). Correlations with non-invasive PAWP estimation were less accurate. Conclusions. LA function assessed by LA strain is associated with haemodynamic conditions in patients with HF. PALS has a strong association with outcomes, independently from other prognosticators. Improvements in LV haemodynamics are strongly associated with enhancements in CTs, promoting more efficient LV filling and possibly pulmonary circulation improvement.