Left atrial remodeling and function in advanced heart failure with preserved or reduced ejection fraction

Area of Science:

• Cardiology
• Cardiac Physiology
• Heart Failure Research

Background:

• Left atrial (LA) structure and function are altered in heart failure (HF) patients.
• Fundamental differences in LA properties may exist between HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF).

Purpose of the Study:

• To investigate and compare the distinct characteristics of left atrial remodeling and function in HFpEF versus HFrEF.
• To determine the association of LA dysfunction with clinical outcomes and comorbidities in different HF phenotypes.

Main Methods:

• 198 HF patients (51% HFpEF) and 40 controls underwent catheterization and echocardiography.
• Analysis included LA volumes, pressures, stiffness, pulsatility, and wall stress variations.
• Follow-up data was used to assess mortality and its association with LA function.

Main Results:

• HF patients exhibited larger and more dysfunctional LA compared to controls.
• At identical mean LA pressure, HFrEF showed larger LA volumes, while HFpEF had increased LA stiffness and pulsatility.
• HFpEF patients had higher rates of atrial fibrillation and LA function was linked to lower mortality in HFpEF.

Conclusions:

• HFrEF is associated with eccentric LA remodeling, whereas HFpEF is characterized by increased LA stiffness, potentially increasing atrial fibrillation burden.
• LA dysfunction correlates with pulmonary vascular disease and right HF in both phenotypes.
• Improved LA function may be a therapeutic target, especially in HFpEF, given its association with outcomes.