The Prognostic Role of the Left Atrium in Hypertensive Patients with HFpEF: Does Function Matter More than Structure?

(1) Background: In arterial hypertension (AH), adverse changes in left atrium (LA) are often observed. The prognostic significance of LA functional vs. structural abnormalities among high-risk AH patients (with heart failure with preserved ejection fraction [HFpEF]) are not clearly defined. (2) Objective: to compare the prognostic significance of LA structural vs. functional indices in hypertensive patients with HFpEF. (3) Methods: We retrospectively selected 274 hypertensive patients with AH, HFpEF and sinus rhythm. The primary outcome was composite of all-cause mortality and HF hospitalization; the median follow-up was 4.3 (2.5–6.5) years. (4) Results: The composite endpoint occurred in 133 patients (49%). The Kaplan-Meier analysis revealed significantly lower event-free survival rates in patients with lower functional LA reservoir strain [LASr] (≤ mediane) compared to patients with higher LASr (P < 0.001). Patients with higher structural LA volume index (LAVI) as well as with higher LV filling pressure (E/e′ ratio) or more severe left ventricular (LV) hypertrophy (higher LV mass index) had a similar prognosis to patients with lower values. In multivariable analysis, decreased LASr and paroxysmal atrial fibrillation (AF) were independently associated with adverse outcomes after accounting for potential confounders (for both P < 0.05). (5) Conclusions: Among patients with AH and HFpEF, LA functional parameter LASr was found to be more effective than structural LA parameter LAVI, and traditional parameters of LV hypertrophy or filling pressure in predicting prognosis.