Key result
Discordant atrial non-recovery in HFrEF is linked to ~3.5-fold higher all-cause mortality despite LV improvement.
Why the study?
Whether discordant recovery between left ventricular and left atrial function carries distinct prognostic implications in HFrEF patients treated with ARNI-based therapy was unknown.
Does discordant left atrial non-recovery (persistent LA dysfunction despite LV functional improvement) predict worse clinical outcomes in HFrEF patients treated with ARNI-based therapy?
Cohort (n=1,182)
Yes
Does discordant left atrial non-recovery (persistent LA dysfunction despite LV functional improvement) predict worse clinical outcomes in HFrEF patients treated with ARNI-based therapy?
In patients with HFrEF treated with ARNI, persistent left atrial dysfunction despite left ventricular functional improvement is a high-risk phenotype with elevated mortality risk, demonstrating the incremental prognostic value of assessing LA strain.
Signals higher mortality risk despite LV recovery on ARNI; supports LA strain for refined prognostication but leaves open therapeutic implications.
AIMS: Assessment of treatment response in HFrEF has largely relied on left ventricular (LV)-centric parameters, yet the left atrium (LA) modulates LV filling and reflects the cumulative hemodynamic burden. Whether discordant recovery between LV and LA function carries distinct prognostic implications in patients treated with ARNI-based therapy remains unknown. METHODS AND RESULTS: From the multicentre STRATS-HF-ARNI registry, 1,182 patients with HFrEF who underwent serial echocardiography at baseline and one-year follow-up were included. Patients were classified according to the change in LVGLS and LASr at one year: Group A, concordant recovery (57.4%); Group B, discordant atrial non-recovery (11.2%); Group C, discordant ventricular non-recovery (15.6%); and Group D, concordant non-recovery (16.0%). Outcomes included all-cause mortality, cardiovascular mortality, and HF hospitalization. Despite achieving LV functional improvement, Group B exhibited persistent LASr deterioration, accompanied by less favourable hemodynamic trajectories than Group A. On multivariable Cox regression, Group B had significantly higher risks of all-cause mortality (adjusted hazard ratio [aHR] 3.53, 95% confidence interval [CI] 1.60-7.79) and cardiovascular mortality (aHR 5.68, 95% CI 1.91-16.92), comparable to Group D. Group C demonstrated higher HF hospitalization risk (aHR 2.25, 95% CI 1.31-3.86). The adverse prognostic impact of discordant atrial non-recovery was consistently observed across subgroups stratified by baseline LVGLS and LASr levels. CONCLUSION: In HFrEF patients treated with ARNI-based therapy, persistent LA dysfunction despite LV functional improvement identifies a high-risk phenotype comparable to concordant non-recovery. These findings suggest that concurrent assessment of LV and LA strain may provide incremental prognostic value beyond LV-centric metrics alone.
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Park et al. (2026) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=1,182). Discordant atrial non-recovery (persistent LA dysfunction despite LV functional improvement) vs. Concordant recovery (improvement in both LV and LA function) was evaluated on All-cause mortality (aHR 3.53, 95% CI 1.60-7.79). In patients with HFrEF treated with ARNI-based therapy, discordant atrial non-recovery despite LV functional improvement was associated with a significantly higher risk of all-cause mortality (aHR 3.53) compared to concordant recovery.
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