Association of Left Atrial Strain With One-Year Clinical Outcomes in Patients Hospitalized With Acute Decompensated Heart Failure With Preserved Ejection Fraction

Background In patients with heart failure with preserved ejection fraction (HFpEF), left atrial (LA) strain represents a new indicator of mechanical atrial dysfunction and an important prognostic marker. However, the clinical significance of serial changes in LA strain during patient follow-up is still not sufficiently elucidated. Objectives To evaluate changes between baseline and one-year follow-up in LA strain during one-year follow-up in patients hospitalized with HFpEF and to investigate their association with major adverse cardiovascular events (MACE). Methods This prospective observational cohort study included 123 consecutive patients hospitalized due to acute decompensated HFpEF. Comprehensive echocardiographic evaluation was performed during index hospitalization and after 12 months. LA reservoir strain was assessed as peak atrial longitudinal strain (PALS). The primary endpoint was MACE, defined as rehospitalization due to worsening heart failure and/or cardiovascular death during one-year follow-up. Results Patients who developed MACE had lower baseline LA strain, higher LAVI, higher E/e′, higher N-terminal pro-B-type natriuretic peptide (NT-proBNP), higher right ventricular systolic pressure (RVSP), lower tricuspid annular plane systolic excursion (TAPSE), and more impaired left ventricular global longitudinal strain (LV GLS) compared with patients without MACE. Assessment at two predefined time points showed overall improvement in LA strain during follow-up, but patients with adverse outcomes remained characterized by persistently impaired LA strain and an unfavorable hemodynamic profile. Atrial fibrillation was more frequently observed among patients who developed MACE. Conclusion Persistently impaired or worsening LA strain during one-year follow-up was associated with adverse outcomes in patients hospitalized with HFpEF. Assessment of LA strain at baseline and one-year follow-up may improve longitudinal risk stratification beyond conventional echocardiographic parameters.