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Prognostic value of left atrial strain in patients with tetralogy of fallot

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Abstract

To demonstrate prognostic utility of left atrial strain (LAS) in adult patients with repaired Tetralogy of Fallot (rTOF). Adults patients with rTOF were prospectively enrolled in this study between years 2011 and 2015. Left atrium (LA) phasic functions were assessed using 2D speckle tracking echocardiography. Association of LA strain (LAS) with primary (any cardiovascular event) and secondary (death, heart failure or arrhythmia) composite endpoints was assessed using Cox regression analysis. Hundred-and-twelve rTOF patients, in whom LAS was feasible and were in sinus rhythm, were included in the final analysis (age 33 ± 10 years, 68[61%] male). Median duration of follow-up was 8.6 [4.2–9.7] years in the study group. Primary composite endpoint was reached in 48 patients (mean event-free survival time: 7.2 [6.6–7.9] years), and secondary composite endpoint was reached in 22 patients (mean event-free survival time: 8.7 [8.1–9.2] years). LA reservoir strain (LAS-r) was defined as tertile groups (1st tertile < 33%, 2nd tertile = 33–44%, 3rd tertile > 44%). Decreasing tertiles of LAS-r was associated with primary and secondary composite endpoints in Kaplan–Meier analysis (p = 0.02 and 0.002, respectively). In univariable Cox-regression, both decreasing LAS-r and LAS-r tertiles were associated with primary and secondary composite endpoints. Adjusted by initial repair age and NT-proBNP quartiles, increased LAS-r was associated with significantly decreased occurrence of experiencing any events (HR = 0.97, CI 0.93–0.99, p < 0.001). Decreasing LAS-r was still associated with primary endpoint when adjusted by left atrium volume index (LAVImax) (HR = 0.96, CI 0.92–0.99, p = 0.01), left ventricle global longitudinal strain (HR = 0.96, CI 0.93–0.99, p < 0.001) or right ventricle free wall longitudinal strain (HR = 0.96, CI 0.93–0.99, p = 0.03). Assessment of LA mechanics with the use of STE has incremental utility in determination of mortality and morbidity in rTOF, and may be implemented in clinical practice.

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The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Cardiology, Erasmus MC, Cardiovascular Institute, Thorax Center, ‘S-Gravendijkwal 230, 3015 CE Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands

    Ferit Onur Mutluer, Daniel J. Bowen, Roderick W. J. van Grootel, Isabella Kardys, Jolien W. Roos-Hesselink & Annemien E. van den Bosch

  2. Yeditepe University Hospital, Istanbul, Turkey

    Ferit Onur Mutluer

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by FOM, DJB, RWJG, IK, JWR-H and AEB. The first draft of the manuscript was written by FOM and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Ferit Onur Mutluer.

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This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Erasmus Medical Center, Rotterdam (EMC 05-01-43-01-05).

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10554_2023_3020_MOESM1_ESM.eps

The association of baseline characteristics with the primary composite and secondary endpoint. HR: hazard ratio, CI: confidence interval, RBBB: right bundle branch block, LV: left ventricle, RV: right ventricle, TAPSE: tricuspid anular planar systolic excursion, AV: aortic valve, AR: aortic valve regurgitation, PV: pulmonary valve, PR: pulmonary valve regurgitation, TR: tricuspid valve regurgitation, NT-Pro-BNP: N-terminal pro-brain natriuretic peptide. Supplementary file1 (EPS 2600 KB)

10554_2023_3020_MOESM2_ESM.eps

The association of left atrial size and function with the primary and secondary composite endpoints. HR: hazard ratio, CI: confidence interval, RBBB: right bundle branch block, LV: left ventricle, RV: right ventricle, TAPSE: tricuspid anular planar systolic excursion, AV: aortic valve, AR: aortic valve regurgitation, PV: pulmonary valve, PR: pulmonary valve regurgitation, TR: tricuspid valve regurgitation, NT-Pro-BNP: N-terminal pro-brain natriuretic peptide. Supplementary file2 (EPS 1927 KB)

Supplementary file3 (DOCX 14 KB)

Supplementary file4 (DOCX 15 KB)

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Mutluer, F.O., Bowen, D.J., van Grootel, R.W.J. et al. Prognostic value of left atrial strain in patients with tetralogy of fallot. Int J Cardiovasc Imaging 40, 527–534 (2024). https://doi.org/10.1007/s10554-023-03020-8

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  • DOI: https://doi.org/10.1007/s10554-023-03020-8

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