The effect of left atrial reservoir strain on right ventricular dysfunction in left-sided heart failure.

Abstract

This study examined the potential of left atrial (LA) reservoir strain to be an independent determinant of right ventricular (RV) dysfunction (RVD) in the context of left-sided heart failure (HF). We recruited 301 patients with HF (age 61.1±10.7 years; 71.1% male) from The First Hospital of China Medical University between 2021 and 2023, comprising a representative sample of both reduced (47.8%) and preserved ejection fraction (EF) (52.2%) phenotypes. Each participant underwent comprehensive transthoracic echocardiography. Conventional echocardiography measured left ventricular (LV) EF and pulmonary artery systolic pressure (PASP), and two-dimensional speckle tracking echocardiography was applied to quantify LV global longitudinal strain (LVGLS), LA reservoir strain, and RV free wall strain. The cohort demonstrated a 48.5% prevalence of RVD (defined as RV free wall strain < |20%|). RVD was associated with higher body surface area [odds ratio (OR) 12.01] and PASP (OR 1.02), lower LVEF (OR 0.92), LVGLS (OR 1.35), and LA reservoir strain (OR 0.82) (all P values <0.05). Critically, LA reservoir strain (OR 0.83; P<0.001) remained independently associated with RVD even after adjustments were made for age, sex, body surface area, atrial fibrillation, diabetes, hypertension, coronary artery disease, LVEF, LVGLS, and PASP. Thus, in left-sided HF, LA reservoir strain independently predicts RVD irrespective of LVEF or PASP, highlighting the critical role of LA function in RVD.