Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5

Left Atrial Long Axis Shortening Allows Effective Quantification of Atrial Function and Optimized Risk Prediction Following Acute Myocardial Infarction
S. J. Backhaus1, S. Rösel1, T. Stiermaier2, J. Schmidt-Rimpler1, R. Evertz1, A. Schulz1, T. Lange1, J. Kowallick3, S. Kutty4, B. Bigalke5, M. Gutberlet6, G. Hasenfuß1, H. Thiele7, I. Eitel2, A. Schuster1
1Herzzentrum, Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Göttingen; 2Medizinische Klinik II / Kardiologie, Angiologie, Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Lübeck; 3Institut Diagnostische und Interventionelle Radiologie, Universitätsmedizin Göttingen, Göttingen; 4Taussig Heart Center, Johns Hopkins Hospital, Baltimore, US; 5CC 11: Med. Klinik für Kardiologie, Charité - Universitätsmedizin Berlin, Berlin; 6Diagnostische und Interventionelle Radiologie, Herzzentrum Leipzig - Universität Leipzig, Leipzig; 7Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig - Universität Leipzig, Leipzig;
Background:

Deformation imaging enables optimized risk prediction following acute myocardial infarction (AMI). However, costly and time-consuming post processing have hindered widespread clinical implementation. Since manual left ventricular long axis strain (LV LAS) has been successfully proposed as a simple alternative for LV deformation imaging, we aimed at the validation of left atrial (LA) LAS.

Methods:

The AIDA STEMI and TATORT-NSTEMI trials recruited 795 patients with ST-elevation MI and 440 with non-ST-elevation MI. LA LAS was assessed as the systolic distance change between the middle of a line connecting the origins of the mitral leaflets and either a perpendicular line towards the posterior atrial wall (LAS90) or a line connecting to the LA posterior portion of the greatest distance irrespective of a predefined angle (LAS). Primary endpoint was major adverse cardiac event (MACE) occurrence within 12 months.

Results:

There were no significant differences between LA LAS and LAS90, both with excellent reproducibility. LA LAS correlated significantly with LA reservoir function (Es, r=0.60, p<0.001). Impaired LA LAS resulted in higher MACE occurrence (HR 0.85, 95% CI 0.82-0.88, p<0.001). LA LAS (HR 0.90, 95% CI 0.83-0.97, p=0.005) and LV global longitudinal strain (GLS, p=0.025) were the only independent predictors for MACE in multivariate analyses. C-statistics demonstrated incremental value of LA LAS in addition to GLS (p=0.016) and noninferiority compared to FT Es (AUC 0.74 vs. 0.69, p=0.256).

Conclusions:

LA LAS provides an accurate estimation of LA function with similar value for risk prediction compared to dedicated deformation imaging. This simple, software-independent approach enables easy clinical implementation and precise risk assessment.


https://dgk.org/kongress_programme/jt2022/aV1260.html