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Optimized Medical Therapy Enhances Left Atrial Strain in HFrEF Patients: A Novel Prognostic Indicator
Session:
SESSÃO DE POSTERS 38 - ANÁLISE DE DEFORMAÇÃO MIOCÁRDICA
Speaker:
Ana Lobato De Faria Abrantes
Congress:
CPC 2025
Topic:
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Theme:
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Subtheme:
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Session Type:
Cartazes
FP Number:
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Authors:
Ana Lobato de Faria Abrantes; Catarina Gregório; Miguel Azaredo Raposo; João Cravo; Daniel Cazeiro; Inês Araújo; Pedro Silva; Daniel Caldeira; Joana Rigueira; Rui Plácido; Fausto J. Pinto; Catarina Sousa
Abstract
<p style="text-align:justify"><span style="font-size:10.5pt"><span style="font-family:Roboto,sans-serif"><span style="color:#242424">Introduction: Left atrial strain (LAS) has emerged as a precise method to evaluate left atrial (LA) function, and recent studies suggest that LAS correlates with NTproBNP levels and adverse outcomes in heart failure (HF) patients (pt). However, the impact of optimized medical therapy (OMT) on LAS remains unclear.</span></span></span></p> <p style="text-align:justify"><span style="font-size:10.5pt"><span style="font-family:Roboto,sans-serif"><span style="color:#242424">Purpose: To evaluate differences in LAS after OMT and to investigate the correlation between LAS and NTproBNP levels at follow-up (FUP).</span></span></span></p> <p style="text-align:justify"><span style="font-size:10.5pt"><span style="font-family:Roboto,sans-serif"><span style="color:#242424">Methods: Single-center retrospective study included pts with HF with reduced ejection fraction (HFrEF) from 2021 to January 2024. Echocardiography data were collected at baseline and at least 3 months after OMT. Speckle tracking LAS was performed using General Electric's post-processing system by two different operators, calculating Reservoir (LASr), Conduit (LASc), and Contractile (LASct) strain. The left atrioventricular coupling index (LACi) was calculated by dividing end-diastolic LA and left ventricular (LV) volumes. For statistical analysis, Chi-square tests, Pearson correlation and T student test were used as appropriate. </span></span></span></p> <p style="text-align:justify"><span style="font-size:10.5pt"><span style="font-family:Roboto,sans-serif"><span style="color:#242424">Results: We included 23 pts, 41% men, with a mean age of 64±9 years. Most pts had dilated cardiomyopathy (50%) followed by ischemic cardiomyopathy (36%). At baseline, 94.5% of pts were in NYHA class II or higher, mean NTproBNP levels were 2721±4756 pg/ml. Differences in treatment at baseline, OMT and FUP are presented in Table 1. At baseline, LAS correlated with LV dysfunction and filling pressures: lower LASct strongly correlated with higher E/E' ratio and LACi (p=0.009, r=0.64; p=0.034, r=0.53, respectively), lower LASc strongly correlated with lower EF (p=0.006, r=-0.596), and lower LASr strongly correlated with lower EF, higher E/E', and LACi (p=0.023, r=0.507; p=0.013, r=-0.706; p=0.007, r=-0.646, respectively). After OMT, there was a significant improvement in LAS (LASc -5.6±3% vs -10.2±7%, p=0.015; LASct -5.5±5% vs -11±6%, p=0.002; LASr 10.8±3% vs 21.8±11%, p<0.001),</span></span></span><span style="font-size:10.5pt"><span style="font-family:Roboto,sans-serif"><span style="color:#ff0000"> </span></span></span><span style="font-size:10.5pt"><span style="font-family:Roboto,sans-serif"><span style="color:#242424">independent of sex, atrial fibrillation, and HF etiology. A strong correlation was observed between LAS improvement and reduction of diuretic dose (LASc p=0.049, r=0.54; LASct p=0.43, r=0.55; LASr p=0.031, r=-0.57) as well as reduction of NTproBNP levels (LASc p<0.001, r=0.717; LASct p=0.001, r=0.657; LASr p<0.001, r=-0.79) during a mean FUP of 13±4 months. Additionally, higher LAS strongly correlated with a reduction of LACi (LASct p=0.021, r=0.63; LASc p=0.02, r=0.63; LASr p<0.001, r=-0.82), indicating improved LA-LV coupling after OMT. The low event incidence prevented assessing LAS-event correlation.</span></span></span></p> <p style="text-align:justify"><span style="font-size:10.5pt"><span style="font-family:Roboto,sans-serif"><span style="color:#242424">Conclusion: In our population, OMT significantly improved LAS, which strongly correlated with NTproBNP levels at FUP. LAS appears to be an important additional parameter in pts with HFrEF, that might provide additional prognostic value but further studies are required.</span></span></span></p>
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