Heart failure & cardiomyopathies

Left Atrial Volumetric Enlargement in Heart Failure With Reduced Ejection Fraction: Obligatory Consequence or Independent Predictor of Outcome?

JACC Heart FailPublished Retrospective cohort study

Main finding · MortalityResult — go to the resultHazard ratio 1.13 per 10 mL/m²

Authors' conclusion

LAVI is an independent predictor of mortality in heart failure stage B or C, with excess risk starting at 40 mL/m2. The prognostic impact of LAVI persisted with a graded relationship in all FMR severity grades, emphasizing its role in risk stratification.

Study context

Population
Patients with HF stage B or C and a first diagnosis of reduced LVEF (<50%) at Mayo Clinic
Participants
13,954 patients
Exposure
LA volume index (LAVI) and long-term mortality, by functional mitral regurgitation (FMR) severity
Outcome
Long-term mortality by left atrial (LA) volume index (LAVI)
Methodological detailssingle-centre
  • Single-centre

Main finding

Mortality

Hazard ratio

1.13 per 10 mL/m²

P < 0.0001

As reported in the abstract

Observational data: associations, not effects.

Further findings

Mean LAVI by FMR severity

LAVI–mortality relationship by FMR grade (subgroup)

Excess-mortality threshold about 40 mL/m² in no-mild FMR
Excess-mortality threshold about 60 mL/m² in severe FMR
Slope of relationship unaltered at each FMR grade
  • P for interaction = 0.35

Interactions of LAVI with LVEF, AF and pulmonary hypertension

Significant interactions between LAVI, LVEF, AF and pulmonary hypertension

Original publication

Left Atrial Volumetric Enlargement in Heart Failure With Reduced Ejection Fraction: Obligatory Consequence or Independent Predictor of Outcome? JACC Heart Fail. Published 11 February 2026. doi:10.1016/j.jchf.2026.102946

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