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The Prognostic Role of the Left Atrium in Hypertensive Patients with HFpEF: Does Function Matter More than Structure?

Artem Ovchinnikov1,2, Alexandra Potekhina1,3, Anastasiia Filatova1,4

  • 1Laboratory of Myocardial Fibrosis and Heart Failure with Preserved Ejection Fraction, National Medical Research Center of Cardiology Named After Academician E.I. Chazov, Academician Chazov St., 15a, 121552 Moscow, Russia.

Life (Basel, Switzerland)
|September 27, 2025
PubMed

Insights

In arterial hypertension with heart failure, reduced left atrial reservoir strain (LASr) predicts worse outcomes. Functional LA assessment, specifically LASr, is more prognostic than structural measures like LAVI in these high-risk patients.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Clinical Hypertension

Background:

  • Arterial hypertension (AH) often leads to adverse hemodynamic changes in the left atrium (LA).
  • The prognostic value of structural versus functional LA abnormalities in high-risk AH patients with heart failure with preserved ejection fraction (HFpEF) remains unclear.

Purpose of the Study:

  • To compare the prognostic significance of structural and functional LA indices in hypertensive patients diagnosed with HFpEF.

Main Methods:

  • Retrospective analysis of 274 hypertensive patients with AH, HFpEF, and sinus rhythm.
  • Primary outcome: composite of all-cause mortality and heart failure hospitalization.
  • Median follow-up duration of 4.3 years.

Main Results:

  • The composite endpoint occurred in 49% of patients.
  • Lower functional LA reservoir strain (LASr) was associated with significantly lower event-free survival (p < 0.001).
  • Higher structural LA volume index (LAVI), LV filling pressure (E/e' ratio), or LV hypertrophy (LV mass index) did not show similar prognostic significance.
  • Decreased LASr and paroxysmal atrial fibrillation were independent predictors of adverse outcomes.

Conclusions:

  • Functional LA parameter LASr appears more effective than structural LA parameter LAVI in predicting prognosis for patients with AH and HFpEF.
  • LASr offers superior prognostic value compared to traditional indices of LV hypertrophy and filling pressure in this patient cohort.
Abstract

Keywords:
diastolic dysfunctionheart failure with preserved ejection fractionleft atriumoutcomestrain

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