title: Left atrial function in heart failure with impaired and preserved ejection fraction.
abstract: OBJECTIVE
  Left atrial structural and functional changes in heart failure are relatively ignored parts of cardiac assessment. This review illustrates the pathophysiological and functional changes in left atrium in heart failure as well as their prognostic value.
  
  
  RESULTS
  Heart failure can be divided into those with systolic dysfunction and heart failure with preserved ejection fraction (HFPEF). Left atrial enlargement and dysfunction commonly occur in systolic heart failure, in particular, in idiopathic dilated cardiomyopathy. Atrial enlargement and dysfunction also carry important prognostic value in systolic heart failure, independently of known parameters such as left ventricular ejection fraction. In HFPEF, there is evidence of left atrial enlargement, impaired atrial compliance, and reduction of atrial pump function. This occurs not only at rest but also during exercise, indicating significant impairment of atrial contractile reserve. Furthermore, atrial dyssynchrony is common in HFPEF. These factors further contribute to the development of new onset or progression of atrial arrhythmias, in particular, atrial fibrillation.
  
  
  CONCLUSIONS
  Left atrial function is an integral part of cardiac function and its structural and functional changes in heart failure are common. As changes of left atrial structure and function have different clinical implications in systolic heart failure and HFPEF, routine assessment is warranted.
authors.affiliation: Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, and Institute of Vascular Medicine, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Fang
authors.initials: F
authors.lastname: Fang
authors.forename: Alex Pui-Wai
authors.initials: AP
authors.lastname: Lee
authors.forename: Cheuk-Man
authors.initials: CM
authors.lastname: Yu
mesh_terms: D001281:Atrial Fibrillation / Q000209:etiology; D016279:Atrial Function, Left; D015444:Exercise / Q000502:physiology; D006325:Heart Atria / Q000473:pathology; D054143:Heart Failure, Systolic / Q000150:complications / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D011379:Prognosis; D013318:Stroke Volume