Pathophysiological mechanisms and prognostic implications of right atrial reservoir strain in patients with heart failure

Abstract Background Renal and hepatic dysfunction complicate the treatment course of patients with heart failure and negatively affect outcomes. Because the right atrium functions as a reservoir between the right ventricle and the venous circulation, a reduced right atrial compliance may enhance venous congestion, thereby promoting worsening renal function and hepatic congestion. Purpose To evaluate the association between RA reservoir strain (RS) and end-organ dysfunction (renal dysfunction and hepatic congestion), as well as survival in patients with advanced HF. Methods RARS was evaluated with speckle-tracking echocardiography in patients with advanced HF (i.e. left ventricular ejection fraction <35% and persistent symptoms of HF despite optimal medical therapy). Linear regression analysis was used to investigate the association between RARS and renal function (i.e. estimated glomerular filtration rate [eGFR]) and hepatic congestion (i.e. gamma-glutamyl transferase [GGT]). Patients were followed-up for all-cause mortality. Results A total of 917 patients (mean age 65±11 years, 76% male) were included. Age, male sex, atrial fibrillation, larger left atrial and right ventricular dimensions and right ventricular systolic dysfunction were all associated with lower RARS values. On multivariable analysis (adjusting for age, sex, hypertension, diabetes mellitus, dyslipidemia, body mass index, ischemic etiology, atrial fibrillation, QRS duration, left ventricular end-diastolic volume, left ventricular ejection fraction, left atrial volume index, RV basal diameter and tricuspid annular plane systolic excursion), RARS was independently associated with eGFR (β 0.076; 95% CI 0.012 to 0.367; p=0.037) and GGT (β −0.122; 95% CI −1.800 to −0.034; p=0.038). On multivariable Cox regression analysis, adjusting for baseline clinical and echocardiographic variables, RARS was independently associated with all-cause mortality (HR 0.984; 95% CI 0.972 to 0.996; p=0.008) (Figure 1 and Table). Conclusion Reduced RARS is independently associated with renal dysfunction and hepatic congestion. In addition, RARS is independently associated with mortality. Consequently, RARS may be useful for the risk-stratification of patients with HF. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): ESC Training Grant App000064741