Identifying early markers of cardiovascular risk beyond left ventricular ejection fraction (LVEF) and left atrial volume remains an important clinical goal. A systematic review and meta-analysis published in Echocardiography evaluated the association between left atrial strain (LAS), measured by speckle-tracking echocardiography, and major cardiovascular outcomes across different populations and cardiovascular diseases.

The analysis followed PRISMA methodology and included studies evaluating LAS as a continuous variable in relation to cardiovascular outcomes. The primary endpoint was a composite of all-cause mortality and heart failure (HF) hospitalization. Sixteen studies involving 13,156 participants were included in the analysis.

Findings

• Lower LAS was associated with a higher risk of the composite outcome of all-cause mortality and HF hospitalization across the overall population (hazard ratio [HR] 0.91; 95% confidence interval [CI] 0.86-0.96).
• Prognostic associations were also observed in patients with HF (HR 0.93; 95% CI 0.89-0.97), ischemic heart disease (HR 0.95; 95% CI 0.91-0.99), and valvular heart disease (HR 0.94; 95% CI 0.90-0.97).
• No significant prognostic association was observed among patients with left ventricular hypertrophy (HR 0.98; 95% CI 0.84-1.15).
• Meta-regression showed that LVEF did not significantly influence the relationship between LAS and cardiovascular outcomes.

Lower LAS was associated with increased risk of major cardiovascular events across a broad range of populations and cardiovascular diseases. The findings support further evaluation of LAS as a prognostic echocardiographic marker beyond conventional cardiac function measures.