Prognostic Value of Left Atrial Reservoir Strain in Left Ventricular Myocardial Noncompaction: A 3.0 T Cardiac Magnetic Resonance Feature Tracking Study

Background The relationship of left atrial (LA) strain to high-risk heart failure (HF) events in patients with left ventricular myocardial noncompaction (LVNC) remains to be thoroughly investigated. Purpose To evaluate the LA performance in patients with LVNC, and to investigate the prognostic value of LA phasic strain on high-risk HF events, and its influencing factors. Study Type Retrospective. Population A total of 95 LVNC patients (74 with LA enlargement [LAE] and 21 without LAE) and 50 healthy controls. Field Strength/sequence A 3.0 T, balanced steady-state free-precession cine imaging. Assessment LA longitudinal strains were measured by cardiac MRI feature tracking technique. LA volume index (LAVI) and LA ejection fraction (LAEF) were calculated. Their intraobserver and interobserver reproducibility were evaluated. The primary outcome was high-risk HF events, a composite of first HF hospitalization, hospitalization for worsening HF and death from HF. Statistical Tests Student's t/Mann-Whitney U, one-way analysis of variance/Kruskal-Wallis, Chi-squared, receiver operating characteristic, Kaplan-Meier, log-rank, Cox regression, Pearson and Spearman correlation and linear regression analyses were performed. The significance threshold was set at P < 0 .05. Results LAEF and LA longitudinal strains decreased in LVNC patients irrespective of the presence of LAE. During a median follow-up of 32.17 months, high-risk HF occurred in 13 (13.68%) patients. Patients with increased LAVI, decreased LAEF and decreased LA longitudinal strain had significantly higher risks of high-risk HF events. In patients with LVNC, LA reservoir strain (epsilon s) was independently associated with high-risk HF (hazard ratio = 23.208 [95% CI: 2.993-179.967]). LV global longitudinal strain (LV GLS) (beta = -1.783 [95% CI: -2.493 to -1.073]) was significantly and independently associated with epsilon s. Intraobserver and interobserver reproducibility was excellent for LAVI, LAEF, and LA strain. Conclusion In patients with LVNC, epsilon s was an independent predictor for high-risk HF events. LV GLS was an independent determinant of epsilon s in LVNC. Evidence Level 4 Technical Efficacy Stage 4

Automated summary

Patients with LVNC have impaired left atrial function, and left atrial longitudinal strain plays a predictive role in high-risk HF events. Left ventricular global longitudinal strain is associated with left atrial reservoir strain.