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Updated: Mar 3, 2026
Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
Left ventricular ejection fraction determines the pattern of left atrial remodeling in patients with heart failure
Federico García-Rodeja Arias1,2, Sonia Eiras2,3,4, Begoña Cardeso Paredes2,3
1Cardiology Department, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
Insights
Left atrial remodeling worsens with declining left ventricular ejection fraction (LVEF) in heart failure (HF) patients without atrial fibrillation (AF). This structural change correlates with biomarkers indicating hemodynamic overload and fibrosis.
Area of Science:
- Cardiology
- Cardiac Imaging
- Biomarker Analysis
Background:
- Left atrial remodeling is a key factor in heart failure (HF) progression, independent of atrial fibrillation (AF).
- Mechanisms and extent of atrial remodeling across the spectrum of left ventricular ejection fraction (LVEF) are not fully understood.
- This study investigates atrial changes in HF patients without AF.
Purpose of the Study:
- To characterize anatomical and functional left atrial changes in heart failure patients without AF.
- To correlate imaging findings with plasma biomarker profiles.
- To assess the impact of LVEF on atrial remodeling.
Main Methods:
- Prospective study of 264 ambulatory HF patients without prior AF.
- Transthoracic echocardiography for functional left atrial analysis.
- Plasma biomarker assessment and LVEF classification (preserved, mildly reduced, reduced).
Main Results:
- Reduced LVEF associated with larger atrial volumes, lower reservoir strain, impaired conduit function, and higher atrial stiffness.
- Elevated natriuretic peptides, extracellular matrix proteins, and inflammation markers observed.
- Atrial strain correlated with fibrosis, inflammation, and wall stress markers, especially in lower LVEF groups.
Conclusions:
- Atrial remodeling severity escalates with decreasing LVEF in HF patients without AF.
- Remodeling aligns with biomarkers of hemodynamic overload and fibrosis.
- Integrating imaging and molecular data may enhance HF risk stratification and phenotyping.
Background:
Structural remodeling of the left atrium contributes to the progression of heart failure (HF), even in the absence of atrial fibrillation (AF). However, the underlying mechanisms and extent of atrial remodeling across the spectrum of left ventricular ejection fraction (LVEF) remain poorly defined. This study aimed to characterize anatomical and functional left atrial changes using multimodal imaging and biomarker profiling in patients with HF without AF.
Methods:
A total of 264 ambulatory patients with HF and no prior AF, all under continuous rhythm monitoring, were prospectively studied. All underwent transthoracic echocardiography with functional analysis of the left atrium and plasma biomarker assessment. Patients were classified according to LVEF into three groups: preserved, mildly reduced, and reduced. Correlations between echocardiographic parameters and circulating biomarkers were analyzed.
Results:
Patients with reduced LVEF showed larger atrial volumes, lower reservoir strain, impaired conduit function, and higher atrial stiffness. Biomarker profiling revealed increased levels of natriuretic peptides and extracellular matrix proteins, along with moderate elevations in inflammation-related markers. Atrial strain was significantly correlated with markers of fibrosis, inflammation, and wall stress, particularly in patients with lower LVEF.
Conclusions:
In patients with HF without AF, the severity of atrial remodeling increases as LVEF declines and aligns with biomarkers of hemodynamic overload and fibrosis. The integration of imaging and molecular parameters may improve risk stratification and phenotyping in HF.
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