Right atrial strain: What does it tell us about cardiac function and prognosis?

Introduction

The role of speckle tracking echocardiography has been expanding thanks to its utility in detecting subtle changes in cardiac function, and has prognostic value. Right atrial (RA) strain has shown promise in prognostication amongst patients with pulmonary hypertension and heart failure. It is associated with RA size, RV function and IVC size. However, its clinical utility and application remain under investigation. We evaluated the associations of right atrial strain with both invasive and non-invasive measure of RV function and the association of RA strain with heart failure hospitalisations and death across a heterogeneous cohort.

Method

A single-centre retrospective analysis of 225 consecutive patients (age 72 ± 11.6 years old; male 56%) with both right heart catheterization (RHC) and TTE. Data regarding unplanned heart failure hospitalisations and death were recorded. Statistical analysis was performed using SAS 15.1 to assess the association between right atrial strain and prespecified echo and haemodynamic measures of right and left heart function and prognosis defined by heart failure hospitalisations and death.

Results

Over a median follow-up of 28 ± 16 months, there were 59 events. RA strain was associated with non-invasive and invasive measures of right and left heart function (see Table 1) with a P-value of < 0.05. Despite the association of impaired RV strain with prognosis, HR: 2.94 (1.14–7.60), RA strain did not appear to be associated independently with prognosis HR: 0.98 (0.95–1.0) P-value = 0.0676.

Conclusion

Right atrial strain is independently associated with both invasive and non-invasive measures of RV function and may be a useful tool to help us assess right heart function. It did not appear to be associated with prognosis despite being independently linked with RV strain, which was strongly associated with prognosis in our cohort.