AIMS Left atrial (LA) mechanical function may play a significant role in the development and progression of heart failure with preserved ejection fraction (HFpEF). We performed a systematic review and meta-analysis to evaluate association of impaired LA function with outcomes in HFpEF. METHODS AND RESULTS Multiple databases were searched for original studies measuring different phases of LA function in HFpEF patients. Comparative LA function between HFpEF patients and healthy controls was assessed by pooling weighted mean differences (WMD). Adjusted hazard ratios (HRs) with 95% confidence intervals were pooled to evaluate the prognostic utility of LA function. Twenty-two studies (2 trials, 20 observational) comprising 1974 HFpEF patients and 751 healthy controls were included. HFpEF patients had decreased LA reservoir [WMD = -12.21% (-15.47, -8.95); P < 0.001], LA conduit [WMD = -5.68% (-8.56, -2.79); P < 0.001], and pump [WMD = -11.07% (-14.81, -7.34); P < 0.001] emptying fractions compared with controls. LA reservoir [WMD = -13.38% (-16.07, -10.68); P < 0.001], conduit [WMD = -4.09% (-6.77, -1.42); P = 0.003], and pump [WMD = -3.53% (-4.47, -2.59); P < 0.001] strains were also significantly lower in HFpEF patients. Decreased LA reservoir strain [HR 1.24 (1.02, 1.50); P = 0.03] was significantly associated with risk of composite all-cause mortality or heart failure hospitalization. CONCLUSIONS Impaired LA function appears to have diagnostic and prognostic value in HFpEF, but whether indices of LA function truly refine discrimination for diagnosis or prognosis remains to be fully determined. Larger studies are needed to better evaluate associations between LA function and clinical outcomes and the role of LA function as a target for novel HFpEF therapies.

中文翻译：

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保留射血分数的心力衰竭左心房功能：系统评价和荟萃分析。

AIMS左心房（LA）的机械功能可能在射血分数（HFpEF）保持不变的心力衰竭的发生和发展中起重要作用。我们进行了系统的审查和荟萃分析，以评估受损的LA功能与HFpEF结局的关联。方法和结果检索了多个数据库以获取原始研究，这些研究测量了HFpEF患者的LA功能的不同阶段。HFpEF患者和健康对照者之间的LA比较功能通过合并加权平均差异（WMD）进行评估。合并具有95％置信区间的调整后的危险比（HR），以评估LA功能的预后效用。包括1974名HFpEF患者和751名健康对照的22项研究（2个试验，20个观察性研究）。HFpEF患者的LA储备减少[WMD = -12.21％（-15.47，-8。95）; P <0.001]，LA导管[WMD = -5.68％（-8.56，-2.79）；P <0.001]，泵[WMD = -11.07％（-14.81，-7.34）；与对照组相比，P <0.001]排空分数。洛杉矶水库[WMD = -13.38％（-16.07，-10.68）; P <0.001]，导管[WMD = -4.09％（-6.77，-1.42）；P = 0.003]，泵[WMD = -3.53％（-4.47，-2.59）；HFpEF患者中的P <0.001]菌株也显着降低。降低了LA储层应变[HR 1.24（1.02，1.50）; P = 0.03]与综合性全因死亡率或心力衰竭住院的风险显着相关。结论LA功能受损似乎在HFpEF中具有诊断和预后价值，但LA功能指标是否真正完善了对诊断或预后的区分尚待完全确定。