Abstract
Abstract only Introduction: The prevalence of heart failure (HF) is rising, particularly in older adults. Left atrial (LA) dysfunction is commonly seen in HF, but it is unclear if it predicts onset or contributes to its development. Hypothesis: LA strain reduction is associated with incident HF in the general elderly population, independent of other risk factors and even in the presence of normal LA volume. Aims: We aimed to investigate the association between reduced LA strain (LAε) and strain rate (LASR) and incident HF in older adults without history of HF or atrial fibrillation (AF), adjusting for HF risk factors and echocardiographic parameters. Methods: We examined 795 participants aged ≥55 from the Cardiovascular Abnormalities and Brain Lesions (CABL) study with no history of HF or AF. LAε pos , LASR pos , LASR early-neg , and LASR late-neg were assessed using speckle-tracking echocardiography for global, reservoir, conduit and pump function, respectively. Incident HF was detected through standardized interviews, in-person visits, active hospital surveillance of admission and discharge ICD-9 codes. LA strain's association with incident HF was assessed using a cause-specific hazards regression model, adjusting for HF risk factors, including incident AF. Results: Mean age was 70.9±9.2 years (297 men, 498 women). During a mean follow-up of 11.4 years, 215 participants (27.0%) developed new-onset HF; incident AF occurred in 98 (12.3%). Left ventricular ejection fraction and global longitudinal strain were not associated with new-onset HF (p=0.06 and p=0.23, respectively). All LA strain measures at baseline were significantly associated with new-onset HF (all p<0.01). In multivariable analysis, only LASR late-neg (adjusted HR per SD decrease 2.31, 95% CI 1.12-4.43) remained independently associated with new-onset HF, after adjusting for LA volumes, left ventricular systolic function, and incident AF. LASR late-neg was especially associated with incident HF in participants with normal LA size (HR 8.64, CI 3.10-24.08). Conclusion: Reduced LA strain during atrial contraction is independently associated with new-onset HF in older adults. LA strain measurement may improve HF risk stratification in older adults, even in the presence of normal LA volume.