Impact of Right Atrial Remodeling in Heart Failure with Preserved Ejection Fraction.

Ikoma, Takahiro; Obokata, Masaru; Okada, Kenya; Harada, Tomonari; Sorimachi, Hidemi; Yoshida, Kuniko; Kato, Toshimitsu; Kurosawa, Koji; Kurabayashi, Masahiko; Murakami, Masami

BACKGROUND Few studies have investigated right atrial (RA) remodeling in heart failure (HF) with a preserved ejection fraction (HFpEF). This study sought to characterize the RA remodeling in HFpEF and to determine its prognostic significance. METHODS AND RESULTS Patients with HFpEF were classified based on the presence of RA enlargement (RA volume index >39 mL/m2 in men and >33 mL/m2 in women). Compared to patients with normal RA size (n=234), patients with RA dilation (n=67) showed a higher prevalence of atrial fibrillation (AF), worse right ventricular (RV) systolic function, more severe pulmonary hypertension (PH), and higher prevalence of mild tricuspid regurgitation (TR), and impaired RA reservoir function, with increased hepatobiliary enzyme levels. AF was strongly associated with the presence of RA dilation (odds ratio [OR] 10.2, CI [4.00-26.1] current AF vs no AF and OR 3.38, CI 1.26-9.07, earlier AF vs no AF). Patients with RA dilation had more than two-fold increased risk of composite outcomes of all-cause mortality or HF hospitalization (adjusted HR 2.01, 95% CI, 1.09-3.70-, p=0.02). The presence of RA dilation also displayed an additive prognostic value over left atrial dilation alone. CONCLUSIONS These data demonstrate that HFpEF with RA remodeling is associated with distinct echocardiographic features characterizing advanced right heart dysfunction with an increased risk of adverse outcomes.