Outcomes and Predictors of Left Atrial Enlargement in Patients Hospitalized with Acute Heart Failure

Background: Left atrial enlargement (LAE) is a common echocardiographic finding in acute heart failure (AHF) and is associated with adverse outcomes. However, its prevalence, predictors, and clinical implications in hospitalized AHF patients are not fully elucidated. Objectives: This primary objective was to determine the prevalence and identify the independent clinical predictors of LAE in a contemporary cohort of patients hospitalized with AHF. A secondary objective was to evaluate the association between LAE and in-hospital outcomes. Methods: In this retrospective cohort study, we analyzed data from 535 adults admitted with AHF over 10 years. LAE was defined as a left atrial volume index >34 mL/m 2 . Patients were stratified into LAE and non-LAE groups. Clinical, laboratory, and echocardiographic data were compared. Independent predictors of LAE were identified using multivariable logistic regression. Results: LAE was present in 374 (69.9%) patients. Compared to the non-LAE group, patients with LAE had a higher prevalence of hypertension (78.9% vs. 67.1%, P = 0.004), hyperlipidemia (60.7% vs. 49.7%, P = 0.018), obstructive sleep apnea (7.0% vs. 2.5%, P = 0.039), and atrial fibrillation (17.9% vs. 5.6%, P < 0.001). The LAE group also had significantly lower hemoglobin levels and estimated glomerular filtration rate. Multivariable analysis identified atrial fibrillation (adjusted odds ratio [aOR]: 3.56, 95% confidence interval [CI]: 1.77–7.97; P = 0.001), heart failure with reduced ejection fraction (HFrEF) (aOR: 2.42, 95% CI: 1.49–3.99; P < 0.001), lower hemoglobin (aOR: 0.89 per g/dL, 95% CI: 0.82–0.97; P = 0.006), and hypertension (aOR: 1.80, 95% CI: 1.14–2.82; P = 0.011) as independent predictors of LAE. Conclusion LAE is highly prevalent among patients hospitalized with AHF and is independently associated with hypertension, atrial fibrillation, HFrEF, and anemia. Routine assessment of left atrial size may enhance risk stratification and inform management strategies in this population.