Schönbauer R, Kammerlander AA, Duca F, et al. - In heart failure with preserved ejection fraction (HFpEF) patients in sinus rhythm (SR), findings demonstrated independent association of impaired LA-EF (left atrial emptying fraction) with worse cardiovascular outcome, which was similar to persistent atrial fibrillation (AF). Left atrial (LA) parameters in persistent AF lost their prognostic ability.

• This study included 188 consecutive HFpEF patients (71% female patients, 70 ± 8 years old), with 92 (49%) in persistent AF.

• The link of LA size and function with a composite endpoint of heart failure hospitalization and cardiovascular death was assessed.

• LA-EF was found to be significantly related to outcome in patients in SR [adjusted hazard ratio 2.14; 95% confidence interval (1.32–3.47) per 1-SD decline, P = 0.002], in multivariate Cox regression adjusted for established risk factors.

• In persistent AF, no LA imaging parameter was associated with outcome.

• LA-EF ≥ 40% was discovered as the best indicator for favourable results in patients with HFpEF and SR.

• Persistent AF was shown to carry a similar risk for adverse outcome vs impaired LA-EF (<40%) in SR.