The following is the summary of “Prevalence, Determinants, and Prognostic Value of Left Atrial Dysfunction in Patients With Chronic Coronary Syndrome and Normal Left Ventricular Ejection Fraction” published in the January 2023 issue of Cardiovascular Disease by Hirose, et al.

Surrogate indicators are important because patients with the chronic coronary syndrome (CCS) still develop cardiovascular disease (CVD) even after they have undergone complete revascularization and their left ventricular (LV) systolic function has returned to normal. As measured by speckle-tracking echocardiography, the left atrial (LA) reservoir strain has become a sensitive predictor for cardiovascular disease. This study aimed to determine how common LA dysfunction is in CCS, what factors contribute to its development, and how useful it is to predict patient outcomes.

Researchers enrolled 278 consecutive patients with CCS who had follow-up echocardiography after completing percutaneous coronary intervention and maintaining LV ejection fraction. The strain in the LA reservoir was measured using a speckle-tracking analyzer, and LA dysfunction was defined as a strain in the LA reservoir of ≤24% or less. Primary outcomes included hospitalization for heart failure, AMI, ACS, stroke, and death from any cause. Individuals, 28 or 10.1%, exhibited LA dysfunction at baseline. Age, hypertension, LV ejection fraction, and multivessel disease were all found to be independent drivers of LA reservoir strain at the (all P<0.05) level or above in a multivariate analysis. In addition, 60 patients (21.6% of the total) experienced the primary result during the median follow-up period of 4.8 years. Adjusted hazard ratio 3.10, P=0.003); the risk increase was still significant after excluding atrial fibrillation from the primary outcome (adjusted hazard ratio 2.27, P=0.043).

LA dysfunction was associated with a significant risk for primary outcome independent of traditional risk factors, LV parameters, and LA size. About 10% of individuals with CCS with a normal LV ejection fraction also exhibited LA dysfunction, which was related to poor cardiovascular outcomes. More research is needed to determine whether therapeutic approaches altering LA remodeling can aid in the prevention of CVD events.

Source: sciencedirect.com/science/article/abs/pii/S0002914922011225