PROGNOSTIC VALUE OF RIGHT ATRIUM ANALYSIS IN PATIENTS WITH NONISCHEMIC CARDIOMYOPATHY

• Published in: Journal of the American Society of Echocardiography
• Main Authors: Lozano-Torres, Jordi, Ródenas-Alesina, Eduard, Tobías-Castillo, Pablo Eduardo, Badia-Molins, Clara, Vila-Olives, Rosa, Calvo-Barceló, Maria, Casas, Guillem, Soriano-Colomé, Toni, San Emeterio, Aleix Olivella, Sao-Avilés, Augusto, Fernández-Galera, Rubén, Méndez-Fernandez, Ana B, Ferreira-González, Ignacio, Rodríguez-Palomares, José
• Format: Journal Article
• Language: English
• Published: 26.06.2025
• ISSN: 1097-6795; 1097-6795
• DOI: 10.1016/j.echo.2025.06.012

Right ventricular (RV) function is associated with a worse prognosis in patients with nonischemic cardiomyopathy (NICM), yet its evaluation may be challenging. Right atrial (RA) volume index (RAVI) and peak RA strain (PRAS) may reflect worse RV diastolic function, but their ability to identify patients at higher risk to predict clinical events in NICM has not been determined.BACKGROUNDRight ventricular (RV) function is associated with a worse prognosis in patients with nonischemic cardiomyopathy (NICM), yet its evaluation may be challenging. Right atrial (RA) volume index (RAVI) and peak RA strain (PRAS) may reflect worse RV diastolic function, but their ability to identify patients at higher risk to predict clinical events in NICM has not been determined.Our study aims to investigate the value of right atrial strain analysis (RAVI and PRAS) in predicting cardiovascular mortality or heart failure hospitalization in a population of patients with nonischemic cardiomyopathy (NICM).OBJECTIVESOur study aims to investigate the value of right atrial strain analysis (RAVI and PRAS) in predicting cardiovascular mortality or heart failure hospitalization in a population of patients with nonischemic cardiomyopathy (NICM).This is a retrospective, unicentric, observational, and longitudinal study. Patients with NICM with a left ventricular ejection fraction <50% and without coronary disease were included, irrespective of atrial rhythm. The primary endpoint was major adverse cardiovascular events (MACE), a composite of heart failure hospitalization or cardiovascular death.METHODSThis is a retrospective, unicentric, observational, and longitudinal study. Patients with NICM with a left ventricular ejection fraction <50% and without coronary disease were included, irrespective of atrial rhythm. The primary endpoint was major adverse cardiovascular events (MACE), a composite of heart failure hospitalization or cardiovascular death.512 patients were included. MACE occurred in 134 patients (26.2%) during a median follow-up of 3.4 years. Multivariable analysis, including RA and RV echocardiographic parameters, identified an increase in RAVI (HR 1.07 for 5mL/m2 increase, 95% CI 1.01 - 1.13, P=0.019) and a decrease in PRAS (HR 0.84 per 5% increase, 95% CI 0.71 - 0.99, P=0.034) independently associated with MACE, with an additive value (increase in Harrell's C=0.033, p=0.043). RAVI remained associated with MACE after a Cox regression adjusted by age, hypertension, chronic kidney disease, and peak left atrium strain, with an HR 1.05 for 5mL/m2 increase in RAVI, 95% CI 1.01 - 1.10, p=0.025.RESULTS512 patients were included. MACE occurred in 134 patients (26.2%) during a median follow-up of 3.4 years. Multivariable analysis, including RA and RV echocardiographic parameters, identified an increase in RAVI (HR 1.07 for 5mL/m2 increase, 95% CI 1.01 - 1.13, P=0.019) and a decrease in PRAS (HR 0.84 per 5% increase, 95% CI 0.71 - 0.99, P=0.034) independently associated with MACE, with an additive value (increase in Harrell's C=0.033, p=0.043). RAVI remained associated with MACE after a Cox regression adjusted by age, hypertension, chronic kidney disease, and peak left atrium strain, with an HR 1.05 for 5mL/m2 increase in RAVI, 95% CI 1.01 - 1.10, p=0.025.In patients with NICM, a larger RAVI identifies patients at higher risk of cardiovascular death or heart failure hospitalization. PRAS provides additive value to RAVI when assessing the risk of MACE in this population.CONCLUSIONSIn patients with NICM, a larger RAVI identifies patients at higher risk of cardiovascular death or heart failure hospitalization. PRAS provides additive value to RAVI when assessing the risk of MACE in this population.