Integrated Atrial Mechanics-Biomarker Profiling Predicts Left Ventricular Ejection Fraction Improvement in Heart Failure with Reduced Ejection Fraction.

LVEF improvement occurred in 45.7% of HFrEF patients followed for 24 months.

• 175 HFrEF patients were followed prospectively for 24 months with serial echocardiography, left atrial (LA) strain and 16 biomarkers.
• LVEF improvement was defined as an increase of at least 10 points to a value above 40%.
• 80 patients (45.7%) met this definition.

Improvers differed from non-improvers in clinical, structural and biomarker characteristics at baseline.

• Improvers were more often women and had non-ischaemic aetiology.
• They had smaller LV volumes, better LV longitudinal strain and shorter atrial conduction time.
• They had lower ANP, relaxin-2 and COL4A1.

Baseline LA volume and LA strain did not differ between improvers and non-improvers.

• Favourable baseline atrial mechanics did not distinguish patients who later improved.
• This contrasts with the differences seen in LV volumes, LV longitudinal strain and atrial conduction time.

An exploratory eight-variable model discriminated improvers from non-improvers, but performance fell after correction for optimism.

• The apparent AUC was 0.93.
• The optimism-corrected AUC was 0.84.
• The model was described as exploratory.

NT-proBNP and LA reservoir strain diverged progressively between improvers and non-improvers over follow-up.

• Serial echocardiography and biomarker measurements over 24 months showed progressively widening differences between groups.
• The authors interpret this as progressive atrial and neurohormonal reverse remodelling.

LVEF improvement was associated with lower mortality and fewer heart failure hospitalisations.

• Mortality: HR 0.25 (95% CI 0.08-0.75).
• Heart failure hospitalisation: HR 0.38 (95% CI 0.18-0.78).

The authors conclude that LVEF improvement reflects progressive atrial and neurohormonal reverse remodelling rather than favourable baseline atrial mechanics.

• Baseline LA volume and strain did not differ between groups, while NT-proBNP and LA reservoir strain diverged over time.
• Integrated atrial mechanics-biomarker profiling was used to characterise the substrate of LVEF improvement.