Predictors of left atrial strain recovery in patients hospitalized with acute heart failure with reduced ejection fraction

Abstract

Aims: Left atrial (LA) function is crucial in heart failure (HF) pathophysiology, and its impairment is associated with adverse outcomes. LA reservoir strain (LASr), assessed via speckle-tracking echocardiography, has emerged as a sensitive marker of LA mechanics, yet its recovery during acute HF remains unclear. This study aimed to identify the clinical and echocardiographic predictors of LASr improvement in patients hospitalized with acute decompensated HF with reduced ejection fraction (HFrEF). Methods: This retrospective study included 63 hospitalized patients with acute decompensated HFrEF (LVEF <40%). Patients were classified into improvers (?15% increase in LASr) and non-improvers based on LASr recovery during hospitalization. Clinical and echocardiographic parameters were compared between groups, and independent predictors of LASr improvement were identified through logistic regression analysis. Model performance was evaluated using ROC and decision curve analyses. Results: LASr improved in 38% of patients (improvers: n=24), increasing from 7.8% (IQR: 4.8–11.5) to 10.0% (IQR: 7.0–13.0, p=0.035). Compared to non-improvers, improvers had higher LVEF (p=0.009), smaller LV end-diastolic diameter (p=0.015), and lower prevalence of moderate-to-severe mitral regurgitation (p=0.012). In multivariate analysis, LVEF (OR: 1.204, 95% CI: 1.040–1.395) and LV end-diastolic diameter (OR: 0.879, 95% CI: 0.780–0.990) predicted LASr recovery, while moderate-to- severe MR was associated with lower recovery (OR: 0.170, 95% CI: 0.029–0.988). ROC analysis confirmed model performance (AUC: LVEF 0.852, EDD 0.831, MR 0.779). Conclusion: LASr improvement during hospitalization is closely linked to baseline LV function, ventricular dimensions, and MR severity, highlighting its dynamic nature in acute HF and potential as a marker of cardiac recovery.