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July 9, 2026Journal of EchocardiographyOpen Access

Higher left atrial reservoir strain predicts ~6% lower MACE risk per unit increase in ACS.

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Why the study?

Does higher left atrial reservoir strain predict lower risk of major adverse cardiovascular events in patients with coronary artery disease?

Population

9,404 patients with coronary artery disease from 17 studies

Design

Meta-analysis

Key result

Higher left atrial reservoir strain was significantly associated with a lower risk of major adverse cardiovascular events in patients with acute coronary syndrome (HR 0.94 per 1% increase).

Authors

TSThitiphan SrikulmontriPWPhuuwadith WattanachayakulSPSuchanart Pantarote

Discussion

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Overview

May refine CAD risk stratification beyond LVEF; extends single-center data but remains hypothesis-generating.

Key Points

  • This research aims to evaluate the prognostic significance of left atrial reservoir strain for major adverse cardiovascular events in patients with coronary artery disease.
  • Systematic review and meta-analysis of studies on left atrial reservoir strain in coronary artery disease patients.
  • Pooled hazard ratios calculated using random-effects models, including subgroup analyses and bias assessments.
  • Seventeen studies with a total of 9,404 patients were analyzed, primarily focusing on acute coronary syndrome populations.
  • Higher left atrial reservoir strain significantly correlates with lower risk of major adverse cardiovascular events (pooled HR per 1% increase = 0.94; 95% CI, 0.92–0.95).
  • This association remains consistent across different imaging modalities and timing of assessment.
  • No separate analysis performed for chronic coronary syndrome due to limited studies.

Study Design

Type

Meta-Analysis (n=9,404)

Structured PICO

Does higher left atrial reservoir strain predict lower risk of major adverse cardiovascular events in patients with coronary artery disease?

P
Population
9,404 adult patients with coronary artery disease, predominantly acute coronary syndrome, from 17 studies followed for a mean of 39.9 months.
E
Exposure
Left atrial reservoir strain (LASr) assessment
O
Outcome
Major adverse cardiovascular events (MACE)composite

Main Result

Hazard Ratio: 0.94 (95% CI 0.92–0.95)

p-value: p=<0.0001

Higher left atrial reservoir strain is a significant prognostic marker for lower risk of major adverse cardiovascular events in patients with acute coronary syndrome.

Limitations

  • Residual heterogeneity remained, which may reflect differences in sample size, proportions of STEMI versus NSTEMI, population demographics, analytic software, and follow-up duration.
  • Meta-regression findings for some variables may be affected by ecological fallacy.
  • The impact of pre-existing AF or structural heart disease could not be assessed, as these conditions were inconsistently excluded across studies.
  • Endpoint definitions varied across studies, with individual MACE components varying and some cohorts not including nonfatal myocardial infarction.
  • Only two studies available for chronic coronary syndrome/stable CAD

Cite This Study

Srikulmontri et al. (2026) conducted a meta-analysis in Coronary artery disease (CAD) / Acute coronary syndrome (ACS) (n=9,404). Left atrial reservoir strain (LASr) vs. Per 1% increase in LASr was evaluated on Major adverse cardiovascular events (MACE) in ACS populations (HR 0.94, 95% CI 0.92-0.95, p=<0.0001). Higher left atrial reservoir strain was significantly associated with a lower risk of major adverse cardiovascular events in patients with acute coronary syndrome (HR 0.94 per 1% increase).

synapsesocial.com/papers/6a4f3be52b81a944af575a52https://doi.org/10.1007/s12574-026-00742-1
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