Impaired left atrial function increases the risk of incident atrial fibrillation and heart failure with preserved ejection fraction in hypertensive patients

Purpose Left atrial (LA) function has emerged as an important marker of LA compliance and has been associated with adverse outcomes in patients with heart failure with reduced ejection fraction (HFrEF). This study aimed to evaluate the association between impaired LA function and the risk of incident atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF). Hypothesis Impaired LA function is associated with an increased risk of incident AF and HFpEF. Methods A total of 268 patients without a prior diagnosis of heart failure or atrial fibrillation were prospectively enrolled according to predefined inclusion and exclusion criteria. Results During a mean follow-up of 36 ± 3 months, 79 patients (29.48%) developed AF and 69 patients (25.75%) developed HFpEF, including 23 patients (8.6%) who developed both conditions. Compared with patients who remained free of both conditions, those who developed AF and/or HFpEF exhibited impaired LA function, reflected by lower LATEF, LAPEF, LAAEF, and LAEI, as well as a higher E/e′ ratio (all P < 0.05). In multivariable Cox regression analyses, LAD, E/e′ ratio, interventricular septal thickness (IVS), and LATEF were independently associated with incident AF. Similarly, E/e′ ratio, LATEF, LAAEF, and IVS were independently associated with incident HFpEF. Patients with lower LATEF had higher risks of all-cause mortality and stroke during follow-up. Conclusion Impaired LA function is associated with an increased risk of AF and HFpEF. Reduced LATEF is independently associated with these outcomes and is further associated with adverse clinical events.