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Reverse atrial remodeling in heart failure with recovered ejection fraction

Sun, Yuxi, Chen, Xuefu, Zhang, Yanli, Yu, Yao, Zhang, Xinxin, Si, Jinping, Ding, Zijie, Xia, Yunlong, Tse, Gary, Liu, Ying and others. (2023) Reverse atrial remodeling in heart failure with recovered ejection fraction. Journal of the American Heart Association, 12 (2). Article Number e026891. E-ISSN 2047-9980. (doi:10.1161/jaha.122.026891) (KAR id:99873)


Background Heart failure with recovered ejection fraction (HFrecEF) has been a newly recognized entity since 2020. However, the concept has primarily focused on left ventricular ejection fraction improvement, with less focus on the recovery of the left atrium. In this study, we investigated changes in left atrial (LA) echocardiographic indices in HFrecEF.

Methods and Results An inpatient cohort with heart failure with reduced ejection fraction (HFrEF) was identified retrospectively and followed up prospectively in a single tertiary hospital. The enrolled patients were classified into HFrecEF and persistent HFrEF groups. Alternations in LA parameters by echocardiography were calculated. The primary outcome was a composite of cardiovascular death or heart failure rehospitalization. A total of 699 patients were included (HFrecEF: n=228; persistent HFrEF: n=471). Compared with persistent HFrEF, the HFrecEF group had greater reductions in LA diameter, LA transverse diameter, LA superior–inferior diameter, LA volume, and LA volume index but not in LA sphericity index. Cox regression analysis showed that the HFrecEF group experienced lower risks of prespecified end points than the persistent HFrEF group after adjusting for confounders. Additionally, 136 (59.6%) and 62 (13.0%) patients showed LA reverse remodeling (LARR) for the HFrecEF and persistent HFrEF groups, respectively. Among the HFrecEF subgroup, patients with LARR had better prognosis compared with those without LARR. Multivariate logistic analysis demonstrated that age and coronary heart disease were 2 independent negative predictors for LARR.

Conclusions In HFrecEF, both left ventricular systolic function and LA structure remodeling were improved. Patients with HFrecEF with LARR had improved clinical outcomes, indicating that the evaluation of LA size provides a useful biomarker for risk stratification of heart failure.

Item Type: Article
DOI/Identification number: 10.1161/jaha.122.026891
Uncontrolled keywords: heart failure with recovered ejection fraction; left atrium; remodeling; reverse
Subjects: R Medicine
Divisions: Divisions > Division of Natural Sciences > Kent and Medway Medical School
Funders: National Natural Science Foundation of China (
SWORD Depositor: JISC Publications Router
Depositing User: JISC Publications Router
Date Deposited: 06 Feb 2023 16:17 UTC
Last Modified: 04 Mar 2024 17:30 UTC
Resource URI: (The current URI for this page, for reference purposes)

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