Left atrial function in heart failure with impaired and preserved ejection fraction

Area of Science:

• Cardiology
• Cardiac Physiology
• Heart Failure Pathophysiology

Background:

• Left atrial (LA) changes are often overlooked in cardiac assessments for heart failure (HF).
• Understanding LA structure and function is vital for comprehensive HF evaluation.

Purpose of the Study:

• To review the pathophysiological and functional changes in the left atrium in HF.
• To highlight the prognostic significance of LA alterations in different HF types.

Main Methods:

• Literature review focusing on LA structural and functional changes in HF.
• Analysis of prognostic data related to LA abnormalities.

Main Results:

• Left atrial enlargement and dysfunction are prevalent in systolic HF, particularly idiopathic dilated cardiomyopathy.
• LA abnormalities hold prognostic value in systolic HF, independent of ejection fraction.
• Heart failure with preserved ejection fraction (HFPEF) exhibits LA enlargement, reduced compliance, and impaired pump function, even during exercise.
• Atrial dyssynchrony in HFPEF contributes to arrhythmias like atrial fibrillation.

Conclusions:

• Left atrial function is integral to overall cardiac function.
• Structural and functional LA changes are common in HF and have distinct clinical implications in systolic HF versus HFPEF.
• Routine assessment of LA structure and function is recommended for all HF patients.