Left Atrial Strain Outperforms Ventricular Strains in Cardiovascular Outcome Association Across Echocardiography and Magnetic Resonance.
Journal
JACC. Asia
ISSN
2772-3747
Date Issued
2026-04
Author(s)
Chiang, Kuang-Chien
Kitano, Tetsuji
Nabeshima, Yosuke
Nagata, Yasufumi
Ju, Seanson C
Takeuchi, Masaaki
Abstract
Background Cardiac chamber strain is associated with outcomes in various diseases. However, it remains uncertain whether left ventricular global longitudinal strain (LVGLS), left atrial reservoir strain (LASr), or right ventricular free wall longitudinal strain (RVfwLS) has the most robust association with outcomes. Objectives The authors aimed to compare head-to-head the associations of LVGLS, LASr, and RVfwLS with major adverse cardiovascular events (MACE) using 2-dimensional speckle tracking echocardiography (2D-STE) and cardiac magnetic resonance feature tracking (CMR-FT). Methods Consecutive patients who underwent clinically indicated echocardiography and cardiac magnetic resonance on the same day were enrolled. Strain was derived from 2D-STE (fully automated and manually edited) and CMR-FT. The primary endpoint was MACE, including cardiac death, heart failure hospitalization, and sustained ventricular tachyarrhythmia. Results We included 550 patients (age 65 ± 15 years, 361 [66%] male). Over a median follow-up of 2.2 years (Q1-Q3: 0.9-4.2 years), 78 (14.3%) patients experienced MACE. LVGLS, LASr, and RVfwLS were independently associated with MACE in separate models after adjusted for key clinical variables. Head-to-head comparisons of 3 strain parameters revealed that LASr remained significantly associated with MACE using 2D-STE (both fully automated and manually edited, HR: 0.91; 95% CI: 0.86-0.95) and CMR-FT (HR: 0.91; 95% CI: 0.86-0.96) (all P ≤ 0.001). Incremental analysis showed that LASr provided additional value beyond clinical parameters and LVGLS (all P < 0.001), while the subsequent addition of RVfwLS did not. Nomogram analyses indicated that LASr had the most significant impact on MACE compared with LVGLS and RVfwLS, as assessed by both 2D-STE and CMR. Conclusions Compared with LVGLS and RVfwLS, LASr exhibited the strongest association with MACE, regardless of the imaging modality used. Incorporating LASr as a routine measurement should therefore be considered. © 2026 The Authors.
Subjects
cardiac magnetic resonance
cohort studies
myocardial strain
risk assessment
speckle tracking echocardiography
Type
journal article