The prognostic value of peak left atrial longitudinal strain in the heart failure development in patients with acquired heart disease

Authors: Averina I.I., Mironenko M.Yu., Bockeria L.A.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

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Type:  Original articles


For citation: Averina I.I., Mironenko M.Yu., Boсkeria O.L. The prognostic value of peak left atrial longitudinal strain in the heart failure development in patients with acquired heart disease. Creative Cardiology. 2021; 15 (4): 510–23 (in Russ.). DOI: 10.24022/1997-3187-2021-15-4-510-523

Received / Accepted:  25.11.2021 / 20.12.2021

Keywords: heart failure peak atrial longitudinal strain left atrium remodeling prognosis

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Objective. To determine the prognostic value of peak atrial longitudinal strain (PALS) of left atrium (LA) in patients with valvular heart diseases after surgery.

Material and methods. 112 patients with valve disease (90 men and 22 women, aged 18–72, Me = 51, Q1–Q3 (35–57)) were included. Patients underwent aortic valve replacement n = 81 (72%), mitral valve replacement n = 27 (24%) or repair n = 4 (4%) and tricuspid valve repair n = 81 (72%). Echo was performed before surgery, in 8–14 days and in 12–36 months of follow-up. The following end points were chosen: progression of heart failure (HF), development of HF with reduced ejection fraction (EF) less than 45% (HFrEF) or HF with preserved EF (HFpEF), prolonged stay in intensive care due to HF signs, re-hospitalization due to HF, all-cause death.

Results. Baseline PАLS LA less than 33% was associated with higher risk of HFrEF after valve surgery (area under the curve (AUC) 0.753 ± 0.075, р = 0.00001, relative risk (RR) 2.13 (confidence interval (CI) 1.47–3.08). Baseline PАLS LA less than 18.6% was associated with higher risk of HFpEF (AUC 0.94 ± 0.03, р=0.00001, RR 8.2 CI (3.61–18.64). The likelihood of postoperative heart failure was increased in patients with PALS decreased during the dobutamine stress test. PALS values during stress less than 25% can be used as an informative indicator for predicting heart failure (with preserved and reduced ejection fraction) after surgery (AUC 0.82, RR 3.15 (CI 1.8–5.51).

Conclusion. PALS revealed a significant prognostic value in relation of the development of postoperative heart failure. PALS can be an additional criterion in determining indications for surgical correction, in optimal management of patients with valve disease.


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About Authors

  • Irina I. Averina, Dr. Med. Sci., Senior Researcher; ORCID
  • Marina Yu. Mironenko, Cand. Med. Sci., Head of Department; ORCID
  • Leo A. Bockeria, Academician of Russian Academy of Sciences and Russian Academy of Medical Sciences, President; ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery