Left atrial function in heart failure with preserved ejection fraction: a systematic review and meta-analysis

Muhammad Shahzeb Khan, Muhammad Mustafa Memon, Mohammad H. Murad, Muthiah Vaduganathan, Stephen J. Greene, Michael Hall, Filippos Triposkiadis, Carolyn S.P. Lam, Amil M. Shah, Javed Butler, Sanjiv J. Shah

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Aims: Left atrial (LA) mechanical function may play a significant role in the development and progression of heart failure with preserved ejection fraction (HFpEF). We performed a systematic review and meta-analysis to evaluate association of impaired LA function with outcomes in HFpEF. Methods and results: Multiple databases were searched for original studies measuring different phases of LA function in HFpEF patients. Comparative LA function between HFpEF patients and healthy controls was assessed by pooling weighted mean differences (WMD). Adjusted hazard ratios (HRs) with 95% confidence intervals were pooled to evaluate the prognostic utility of LA function. Twenty-two studies (2 trials, 20 observational) comprising 1974 HFpEF patients and 751 healthy controls were included. HFpEF patients had decreased LA reservoir [WMD = −12.21% (−15.47, −8.95); P < 0.001], LA conduit [WMD = −5.68% (−8.56, −2.79); P < 0.001], and pump [WMD = −11.07% (−14.81, −7.34); P < 0.001] emptying fractions compared with controls. LA reservoir [WMD = −13.38% (−16.07, −10.68); P < 0.001], conduit [WMD = −4.09% (−6.77, −1.42); P = 0.003], and pump [WMD = −3.53% (−4.47, −2.59); P < 0.001] strains were also significantly lower in HFpEF patients. Decreased LA reservoir strain [HR 1.24 (1.02, 1.50); P = 0.03] was significantly associated with risk of composite all-cause mortality or heart failure hospitalization. Conclusions: Impaired LA function appears to have diagnostic and prognostic value in HFpEF, but whether indices of LA function truly refine discrimination for diagnosis or prognosis remains to be fully determined. Larger studies are needed to better evaluate associations between LA function and clinical outcomes and the role of LA function as a target for novel HFpEF therapies.

Original languageEnglish (US)
Pages (from-to)472-485
Number of pages14
JournalEuropean Journal of Heart Failure
Issue number3
StatePublished - Mar 1 2020


  • Heart failure with preserved ejection fraction
  • Left atrium
  • Meta-analysis
  • Remodelling

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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