Why the study?
Clinical focus in HF reverse remodelling remains predominantly on the LV, and consensus is lacking regarding the prevalence and prognostic impact of left atrial reverse remodelling in relation to left ventricular reverse remodelling.
Does combined left ventricular and left atrial reverse remodelling improve 10-year survival compared to isolated left ventricular reverse remodelling in patients with heart failure and baseline LVEF <40%?
Cohort (n=7,981)
Does combined left ventricular and left atrial reverse remodelling improve 10-year survival compared to isolated left ventricular reverse remodelling in patients with heart failure and baseline LVEF <40%?
In patients with heart failure experiencing functional LVEF recovery, concurrent left atrial reverse remodelling is associated with significantly lower 5- and 10-year mortality compared to isolated left ventricular normalisation, highlighting persistent atrial dilatation as a marker of residual mortality risk.
Persistent LA dilatation signals residual mortality risk after LVEF recovery; extends reverse remodeling data but leaves open prospective validation.
Background Heart failure (HF) phenotypes are clinically classified based on left ventricular ejection fraction (LVEF). While cardiac reverse remodelling is a well-established marker of favourable outcome, clinical focus remains predominantly on the left ventricle (LV), which may underestimate significant structural changes in other chambers. The left atrium (LA) is a sensitive marker of haemodynamic burden and filling pressures; however, consensus is lacking regarding the prevalence and prognostic impact of left atrial reverse remodelling (LARR) in relation to left ventricular reverse remodelling (LVRR). Purpose To simultaneously analyse atrial and ventricular reverse remodelling to classify recovery phenotypes in patients with HF and evaluate the impact of structural dissociation on 10-year survival. Methods A retrospective cohort study (2006–2019) included 7,981 patients with baseline LVEF <40%. Subjects were stratified by functional recovery (Total: LVEF ≥50%; Partial: LVEF 40–49%) and by diameter normalisation patterns: combined (LV/LA), isolated (LV or LA only), and absent. Statistical analysis included Pearson correlation and Kaplan–Meier survival curves with log-rank tests. Results In the total functional recovery group (n=1,005), isolated ventricular normalisation (LV only) was predominant (40.8%), surpassing the combined LV/LA profile (30.9%). A weak correlation was found between LVEF gain and atrial reduction (r=0.169). In the partial recovery group (n=1,494), absent structural improvement predominated (44.2%), with near-zero atrial variation (0.12%). Survival analysis at 5 and 10 years revealed that LA normalisation significantly reduces mortality: in the total functional recovery group, mortality decreased from 20.2% (isolated LV) to 8.0% (combined LV/LA); in the partial recovery group, it fell from 31.1% (isolated LV) to 16.5% (combined LV/LA) (p < 0.001). Conclusion Functional recovery is frequently independent of structural recovery; thus, current definitions of reverse remodelling may underestimate patient prognosis. Persistent atrial dilatation in patients with normalised LVEF suggests residual cardiac impairment, which maintains elevated mortality rates.
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Silva et al. (2026) conducted a cohort in Heart failure with reduced ejection fraction (baseline LVEF <40%) (n=7,981). Combined left ventricular and left atrial reverse remodelling (LV/LA diameter normalisation) vs. Isolated left ventricular reverse remodelling (LV normalisation only) was evaluated on Mortality at 5 and 10 years (p=< 0.001).
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