Left Atrial Strain Associated with Functional Recovery in Patients Receiving Optimal Treatment for Heart Failure.

BACKGROUND Heart failure with recovered ejection fraction (HFrecEF) has been reported in several previous studies to have a better prognosis than HF with reduced EF (HFrEF). However, the factors associated with HFrecEF have not been identified. We hypothesized that left atrial (LA) strain could help to identify patients with recovered EF among cases of HF with low EF on admission. METHODS We enrolled 100 consecutive patients hospitalized for the first time due to new-onset HF. Patients were clinically diagnosed with HFrEF on admission (LVEF <40%) and underwent optimal treatment for HF. Twenty-eight patients improved to HFrecEF during 6 months of follow-up. RESULTS Regarding clinical background, there were significantly more females and a lower rate of atrial fibrillation in the HFrecEF group than in the HFrEF group. In the multivariable logistic regression analysis, LA strain was an independent predictor of HFrecEF, even after adjustment for gender and LVEF (OR: 4.06, 95% CI: 2.04-8.07, P < 0.001). A cutoff value of 10.8% for LA strain showed high sensitivity (96%) and specificity (82%) in identifying HFrecEF in HF patients presenting with low EF on admission. During a follow-up period of 24 ± 13 months, 31 patients (31%) had cardiovascular death or readmission due to HF. Patients with reduced LA strain (less than 10.8%) had significantly shorter event-free survival than preserved LA strain (P = 0.02). CONCLUSION LA strain is a useful indicator for predicting HFrecEF and should be considered as a routine measurement in patients with HFrEF on admission.