Investigating Left Atrial Diameter and Heart Failure Onset in Middle‐Aged and Elderly: A Retrospective‐Prospective Study

BACKGROUND: Left atrium (LA) is an integral component of left heart remodeling, reflecting hemodynamics and ventricular status. It remains uncertain whether left atrial diameter (LAD) can be utilized for predicting and evaluating the occurrence of heart failure (HF) in middle-aged and elderly individuals. METHODS: The study aimed to explore the correlation between LAD and HF in middle-aged and elderly individuals, elucidating the timing of occurrence HF in relation to LAD. The retrospective-prospective study investigated 4025 patients who underwent echocardiography at Zhongshan Hospital's Cardiovascular Department from January 2015 to December 2017. Patients were continuously monitored for HF until January 31, 2024. Cox regression analyses related baseline LAD to HF incidence, adjusted for known risk factors. RESULTS: A total of 4025 individuals (mean age: 55 years, 45.29% male) were studied, spanning ages 45-91. Fifty-one developed HF during a median follow-up of 4.36 years. Cox regression model demonstrated the association between HF and LAD (HR = 5.721, 95% CI 3.768-8.687, p < 0.001) even after adjusting for covariates (age, weight, eGFR, HDL-C, lymphocyte count, systolic blood pressure, FPG, HbA1C, waist circumference, hip circumference, valvular disease history, atrial fibrillation history). CONCLUSIONS: The link between LAD and future HF occurrence risk among middle-aged and older adults shows a dose-response pattern. This relationship persists post-adjustment for HF-related factors, highlighting the predictive value of LAD in forecasting HF incidence.