The prognostic value of left atrial dyssynchrony measured by speckle tracking echocardiography in the general population

LA dyssynchrony is a predictor of cardiovascular morbidity in various patient populations. However, the prognostic value of LA dyssynchrony as evaluated by two-dimensional speckle tracking (2D-STE) in the general population is unknown. A cohort of 375 participants without atrial fibrillation (AF), ischemic heart disease (IHD), heart failure (HF) or previous ischemic stroke (IS) had an echocardiogram, including LA 2D-STE, performed. LA dyssynchrony was defined as the standard deviation of the time to peak regional LA reservoir strain values. The endpoints were all-cause mortality, a combined endpoint of AF and IS, and a combined endpoint of major adverse cardiovascular events (MACE) comprised of acute myocardial infarction (AMI), HF or cardiovascular death (CVD). During a median follow up of 16.1 years (IQR 15.0-16.3 years), 83 (22%) participants died, 60 (15%) reached the composite endpoint of AF and IS, and 38 (10%) reached the composite MACE endpoint. LA dyssynchrony was a univariable predictor of all-cause mortality (HR 1.07, 95% CI 1.02-1.11, p = 0.001) but was not significantly associated with the combined endpoint of AF and IS (HR 1.05, p = 0.064) nor MACE (HR 1.04, p = 0.22). However, when adjusted for age, LA dyssynchrony did not predict all-cause mortality (HR 1.03, p = 0.28). Similarly, after further adjustments for clinical and echocardiographic parameters LA dyssynchrony did not predict any of the study outcomes. In this general population study, LA dyssynchrony was not an independent predictor of all-cause mortality and did not predict MACE nor a composite outcome consisting of AF and IS.