The analysis of left atrial function predicts the severity of functional impairment in chronic heart failure: The FLASH multicenter study

Matteo Cameli, Carlotta Sciaccaluga, Ferdinando Loiacono, Iana Simova, Marcelo H. Miglioranza, Dan Nistor, Francesco Bandera, Michele Emdin, Alberto Giannoni, Marco M. Ciccone, Fiorella Devito, Andrea Igoren Guaricci, Stefano Favale, Matteo Lisi, Giulia E. Mandoli, Michael Henein, Sergio Mondillo

Research output: Contribution to journalArticlepeer-review


Background: Heart failure (HF) patients present with a variety of symptoms at different stages of the disease, but the underlying pathophysiology still is unclear. Left atrial (LA) function might be tightly related to changes in patients' symptoms, more than morphological and anatomic heart features, measurable by ultrasound imaging technique. This study sought to investigate the correlation between LA function, assessed by Speckle Tracking Echocardiography (STE) and Quality of Life (QoL), assessed by the Minnesota Living with Heart Failure Questionnaire (MLHFQ), in patients with chronic HF. Methods: Clinically stable HF outpatients (n = 369) were enrolled from 7 different international centres and underwent echocardiographic studies. Patients >75 years old and with atrial fibrillation were excluded. LA strain during reservoir phase (LASr) by STE was measured in all subjects by averaging the 6 atrial segments. LA size was assessed using biplane volume and 4-chamber area acquisition. Results: LASr strongly correlated with both MLHFQ total score (r = −0.87; p < 0.0001). Less significant correlations between MLHFQ and either LA volume or left ventricular global longitudinal strain (LV-GLS) were found (r = 0.28; p = 0.05 and r = 0.30; p = 0.01, respectively). No significant correlation was found between MLHFQ score, LVEF (r = −0.15; p = ns), E/E' ratio (r = 0.19; p = ns), and E/A ratio (r = 0.20; p = ns). Among all echocardiographic parameters analyzed, LASr presented the highest diagnostic accuracy (AUC = 0.74) in predicting a poor QoL (>45), when compared with LV-GLS (AUC = 0.61), LA volume (AUC = 0.54) and E/e' ratio (AUC = 0.51). Conclusions: In patients with HF, irrespective of etiology, LA function strongly correlates with patients' QoL.

Original languageEnglish
Pages (from-to)87-91
Number of pages5
JournalInternational Journal of Cardiology
Publication statusPublished - Jul 1 2019


  • Heart failure
  • LASr
  • Left Atrial Function
  • Left atrial volume
  • Speckle tracking echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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