Left Atrial Strain Predicts Outcome in Populations With and Without Specific Cardiovascular Diseases Across the Range of Ejection Fraction: A Systematic Review and Meta‐Analysis

Aims: Atrial function measured by left atrial strain (LAS) could represent an early marker of disease and poor cardiovascular outcome. Given the importance of identifying early markers of adverse outcome beyond let ventricular ejection fraction (LVEF) and left atrial volume (LAV), our aim was to assess the association of LAS with major cardiovascular events, both in the general population and in specific cardiovascular diseases. Methods and results: We systematically searched PUBMED, COCHRANE Central Register of Controlled Trials and WEB OF SCIENCE (WoS) up to October 2023. Studies were included if they assessed LAS, measured by speckle-tracking echocardiography and analyzed as a continuous variable, and cardiovascular outcome. The primary endpoint was a composite of all-cause death and heart failure (HF) hospitalizations. A meta-analysis following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework was conducted. Sixteen reports including 13156 participants were eligible. LAS predicted outcome in a population with and without a variety of cardiovascular conditions (HR 0.91; 95% CI 0.86-0.96). The result was confirmed in patients with HF (HR, 0.93; 95% CI, 0.89-0.97), IHD (HR, 0.95; 95% CI 0.91-0.99) or VHD (HR, 0.94; 95% CI, 0.90-0.97), but not in patients with LVH (HR, 0.98; 95% CI, 0.84-1.15). The metaregression conducted considering LVEF values as a covariate showed no significant effect on the main effect size. Conclusions: LAS represents a powerful predictor of major cardiovascular events in the general population and in patients with different cardiovascular diseases across left ventricular ejection fraction (LVEF) ranges.