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Updated: Feb 16, 2026
Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
The importance of integrated left atrial evaluation: From hypertension to heart failure with preserved ejection
Matteo Beltrami1,2, Alberto Palazzuoli3, Luigi Padeletti4
1Cardio-Thoracic and Vascular Department, University of Florence, Florence, Italy.
Insights
Left atrial (LA) size and function are crucial for evaluating diastolic dysfunction in hypertension (HT) and heart failure with preserved ejection fraction (HFpEF). A multi-modality approach integrating LA characteristics improves diagnosis and risk stratification.
Area of Science:
- Cardiology
- Cardiac Imaging
- Diagnostic Tools
Background:
- Left atrial (LA) size and function are integral to cardiac evaluation, especially for non-invasive analysis of diastolic function in patients with hypertension (HT) and heart failure with preserved ejection fraction (HFpEF).
- Diastolic dysfunction classification remains challenging, with atrial size and function being key factors for left ventricular (LV) filling.
- Chronic LA remodeling, a consequence of pressure overload, is linked to increased neurohormonal, proarrhythmic, and prothrombotic activities.
Purpose of the Study:
- To propose a multi-modality approach for analyzing LA geometry and function.
- To integrate diastolic flow with LA characteristics and remodeling using traditional and novel diagnostic tools.
- To enhance the understanding and classification of diastolic dysfunction in relevant patient populations.
Main Methods:
- Systematic review of key literature on LA size, function, and diastolic dysfunction.
- Inclusion of studies focusing on patients with HFpEF, HT, and/or atrial fibrillation (AF).
- Discussion of traditional and emerging diagnostic tools for LA assessment.
Main Results:
- Pulsed and tissue Doppler assessments are valuable for estimating LV filling pressure, atrio-ventricular coupling, and LV relaxation in HFpEF and HT.
- LA morphology and function evaluation are essential additions to Doppler assessments.
- Integrated LA evaluation is crucial for patients at high arrhythmic risk, as eccentric LA remodeling and stiffness correlate with AF risk.
Conclusions:
- Mandatory evaluation of LA size, volume, function, and structure in managing patients with HT, HFpEF, and AF.
- A multi-modality approach offers additional insights, identifying patients with severe LA remodeling.
- Further multicenter studies are needed to optimize LA measurement techniques and establish recognized cut-offs for accurate cardiac imaging assessment.
Aim:
Functional analysis and measurement of left atrium are an integral part of cardiac evaluation, and they represent a key element during non-invasive analysis of diastolic function in patients with hypertension (HT) and/or heart failure with preserved ejection fraction (HFpEF). However, diastolic dysfunction remains quite elusive regarding classification, and atrial size and function are two key factors for left ventricular (LV) filling evaluation. Chronic left atrial (LA) remodelling is the final step of chronic intra-cavitary pressure overload, and it accompanies increased neurohormonal, proarrhythmic and prothrombotic activities. In this systematic review, we aim to purpose a multi-modality approach for LA geometry and function analysis, which integrates diastolic flow with LA characteristics and remodelling through application of both traditional and new diagnostic tools.
Methods:
The most important studies published in the literature on LA size, function and diastolic dysfunction in patients with HFpEF, HT and/or atrial fibrillation (AF) are considered and discussed.
Results:
In HFpEF and HT, pulsed and tissue Doppler assessments are useful tools to estimate LV filling pressure, atrio-ventricular coupling and LV relaxation but they need to be enriched with LA evaluation in terms of morphology and function. An integrated evaluation should be also applied to patients with a high arrhythmic risk, in whom eccentric LA remodelling and higher LA stiffness are associated with a greater AF risk.
Conclusion:
Evaluation of LA size, volume, function and structure are mandatory in the management of patients with HT, HFpEF and AF. A multi-modality approach could provide additional information, identifying subjects with more severe LA remodelling. Left atrium assessment deserves an accurate study inside the cardiac imaging approach and optimised measurement with established cut-offs need to be better recognised through multicenter studies.
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