Reduced left atrial strain is associated with worse outcomes in coronary embolism.

Abstract

Coronary embolism (CE) is an uncommon cause of acute myocardial infarction (AMI), representing around 3% of cases. Left atrial strain (LAS) has emerged as a promising tool for assessing atrial function, however its prognosis role in CE remains unsettled. We retrospectively analyzed 100 consecutive patients with CE that was diagnosed based on criteria encompassing clinical, angiographic and diagnostic imaging findings. We evaluated in-hospital and long-term outcomes. Among the 100 patients, 28 experienced adverse in-hospital events. In the univariate analysis, lower estimated glomerular filtration rate, peak troponin I, lower LAS reservoir, atrial fibrillation (AF), right ventricular dysfunction (RVD), mitral regurgitation and reduced left ventricular ejection fraction were associated with in-hospital events. Multivariate analysis confirmed reduced LAS reservoir (OR 0.88, 95%CI 0.81-0.95; p = 0.03), AF (OR 15, 95%CI 1.4-168; p = 0.02), and RVD (OR 18, 95% CI 1.2-275; p = 0.04) as independent predictors of adverse in-hospital outcomes. After a median follow-up of 26 months, 21 patients (23%) experienced adverse long-term events. In the univariate analysis chronic kidney disease, STEMI presentation, RVD and lower LAS reservoir were associated with worse long-term outcomes. In multivariate analysis, reduced LAS reservoir (HR 0.9 (95%CI 0.84-0.98; p = 0.02)) remained a significant predictor of long-term adverse outcomes. On the log-rank test using the discriminatory cutoff value of LASr < 17.5%, LASr was associated with higher risk of long-term outcomes (p < 0.001). Reduced LAS is associated with worse in-hospital and long-term outcomes in patients with CE. These findings highlight the potential role of LAS as a valuable prognostic tool in CE.