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The value of LA reservoir strain to predict new-onset AF in a STEMI population has not been thoroughly investigated. We aimed to explore the incremental value of LA reservoir strain for predicting new-onset AF post-STEMI. Data were analyzed retrospectively from an ongoing STEMI registry. LA reservoir strain\u2009&lt;\u200923% on transthoracic echocardiography was used as threshold for impaired LA function. The endpoint was new-onset AF. In total, 1238 patients (age 60\u2009\u00b1\u200912 years, 75% male) were included. After a median follow-up of 23 months, 92 (7.4%) patients developed new-onset AF. A similar prevalence of LA volume index\u2009\u2265\u200934 ml\/m<jats:sup>2<\/jats:sup> was seen between post-STEMI patients who developed new-onset AF and those who did not. In contrast, impaired LA reservoir strain was 1.5 times more common in individuals who developed AF (72% versus 48%; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Cumulative, event-free survival rates at five years in patients with preserved versus impaired LA reservoir strain were 93% versus 84%, respectively (log-rank \u03c72\u2009=\u200919.81; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). On multivariate Cox regression analysis LA reservoir strain remained significantly associated with new-onset AF (HR 0.97 (95% CI: 0.94\u20130.99); <jats:italic>p<\/jats:italic>\u2009=\u20090.025). Addition of LA reservoir strain provided incremental prognostic value over baseline clinical and echocardiographic risk markers (\u03c72 56.93 vs. 59.98; <jats:italic>p<\/jats:italic>\u2009=\u20090.013). Impaired LA reservoir strain was 1.5 times more common in patients who experienced new-onset AF post-STEMI, and was of incremental value for predicting the development of AF after adjusting for clinical and echocardiographic risk factors.<\/jats:p>\n          <jats:p>\n            <jats:bold>Graphical abstract<\/jats:bold>\n          <\/jats:p>\n          <jats:p>Impaired LA reservoir strain was 1.5 times more common in patients who experienced\u00a0new-onset AF post-STEMI, and was of incremental value for predicting the development of AF.<\/jats:p>","DOI":"10.1007\/s10554-025-03458-y","type":"journal-article","created":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T22:04:39Z","timestamp":1751666679000},"page":"1577-1587","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Incremental prognostic value of left atrial reservoir strain after ST-segment elevation myocardial infarction for the prediction of new-onset atrial fibrillation"],"prefix":"10.1007","volume":"41","author":[{"given":"Laima","family":"Caunite","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rinchyenkhand","family":"Myagmardorj","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xavier","family":"Galloo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dorien","family":"Laenens","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan","family":"Stassen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takeru","family":"Nabeta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Idit","family":"Yedidya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Chiara","family":"Meucci","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jurrien H.","family":"Kuneman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Inge J.","family":"van den Hoogen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sophie E.","family":"van Rosendael","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hoi W.","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victor M.","family":"van den Brand","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adrian","family":"Giuca","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karlis","family":"Trusinskis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nina Ajmone","family":"Marsan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeroen J.","family":"Bax","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pieter","family":"van der Bijl","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,7,5]]},"reference":[{"issue":"2","key":"3458_CR1","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1093\/eurheartj\/ehx393","volume":"39","author":"B Ibanez","year":"2017","unstructured":"Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H et al (2017) 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European society of cardiology (ESC). 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Jeroen J Bax received speaker fees from Abbott Vascular, Edwards Lifesciences and Omron. Nina Ajmone Marsan received speaker fees from Abbott Vascular, Philips Ultrasound, Omron, GE Healthcare and Pfizer. Karlis Trusinskis has received speaker fees from Abbvie, Astra Zeneca, Bayer, Berlin Menarini, Boehringer-Ingelheim, Biotronik, Medtronic, Novo-Nordisk, Pfizer and Servier. All other authors have no relationships relevant to the contents of this paper to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All data used in the current analysis were collected for routine clinical purposes and handled anonymously. The requirement for written informed consent was waived by the institutional review board on a patient level due to the retrospective design of the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}