Impaired left atrial function in heart failure with preserved ejection fraction

Angela B S Santos, Elisabeth Kraigher-Krainer, Deepak K. Gupta, Brian Claggett, Michael R. Zile, Burkert Pieske, Adriaan A. Voors, Marty Lefkowitz, Toni Bransford, Victor Shi, Milton Packer, John J V McMurray, Amil M. Shah, Scott D. Solomon

Research output: Contribution to journalArticlepeer-review

187 Scopus citations


Aims Left atrial (LA) enlargement is present in the majority of heart failure with preserved ejection fraction (HFpEF) patients and is a marker of risk. However, the importance of LA function in HFpEF is less well understood.

Methods and results The PARAMOUNT trial enrolled HFpEF patients (LVEF ≥45%, NT-proBNP >400-pg/mL). We assessed LA reservoir, conduit, and pump function using two-dimensional volume indices and speckle tracking echocardiography in 135 HFpEF patients in sinus rhythm at the time of echocardiography and 40 healthy controls of similar age and gender. Systolic LA strain was related to clinical characteristics and measures of cardiac structure and function. Compared with controls, HFpEF patients had worse LA reservoir, conduit, and pump function. The differences in systolic LA strain (controls 39.2-±-6.6% vs. HFpEF 24.6-±-7.3%) between groups remained significant after adjustments and even in the subsets of HFpEF patients with normal LA size or without a history of AF. Among HFpEF patients, lower systolic LA strain was associated with higher prevalence of prior HF hospitalization and history of AF, as well as worse LV systolic function, and higher LV mass and LA volume. However, NT-proBNP and E/E′ were similar across the quartiles of LA function.

Conclusions In this HFpEF cohort, we observed impairment in all phases of LA function, and systolic LA strain was decreased independent of LA size or history of AF. LA dysfunction may be a marker of severity and play a pathophysiological role in HFpEF.

Original languageEnglish (US)
Pages (from-to)1096-1103
Number of pages8
JournalEuropean Journal of Heart Failure
Issue number10
StatePublished - Oct 1 2014


  • Atrial strain
  • Diastolic heart failure
  • Echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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