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Background Left atrial (LA) volume is a marker of cardiac remodeling and prognosis in heart failure (HF) with reduced ejection fraction (EF), but LA function is rarely measured or characterized. We investigated determinants and prognostic impact of LA reservoir function in patients with HF with reduced EF. Methods and Results In 405 patients with stable HF with reduced EF (EF, ≤40%) in sinus rhythm, we assessed LA reservoir function by both LA total EF (by phasic volume changes) and peak atrial longitudinal strain (PALS; by speckle tracking echocardiography); LA functional index was also calculated. During follow-up (median, 30 months; Q1–Q3, 13–52), 139 patients (34%) reached the composite end point (all-cause death/HF hospitalization). Median PALS was 15.5% (interquartile range, 11.2–20.6). By univariable analysis, all LA function parameters significantly predicted outcome ( P P =0.030). Adding PALS to a base model, including age, sex, LA volume, EF, E/E′ ratio, and global longitudinal strain, provided incremental predictive value (continuous net reclassification improvement, 0.449; P =0.0009). Conclusions In HF with reduced EF, assessment of LA reservoir function by PALS allows powerful prognostication, independently of LA volume and left ventricular longitudinal contraction.

Background : In uncomplicated hypertensive patients with preserved left ventricular (LV) function, enhanced left atrial systolic force (LASF) is associated with LV hypertrophy. In contrast, in patients with prevalent cardiovascular disease, reduced LASF has been shown to be associated with incident atrial fibrillation and poor cardiovascular prognosis. To date the relation between LASF and LV filling pressures in patients with systolic heart failure (HF) has not been adequately investigated. Methods : Doppler echocardiographic measurements of LV systolic, diastolic, and Tissue-Doppler longitudinal function, were obtained in 108 patients (66±12 years; 20% women) with systolic HF [NYHA class III; ejection fraction Results : In the overall population, LASF averaged 10.7±5.8 kdynes. LASF was significantly reduced in patients showing RF (n = 43; 39.8% of study population) compared to non-RF patients (8.1±4.8 vs 12.5±5.8 kdynes, p Conclusions : In systolic HF patients in class NYHA III, left atrial systolic force is reduced in the presence of restrictive filling pattern due in part to increased LV end-diastolic pressure, also associated with reduced LV systolic performance. In CHF patients, increased LVEDP partially blunts LA atrial function, and might be considered as an index of atrial afterload.