Left Atrial Function and Incident Heart Failure in Older Adults

Background: Heart failure (HF) prevalence is increasing, especially among older adults. Left atrial (LA) dysfunc- tion is often associated with HF, but it is unclear whether it may contribute to its development. We investigated whether measures of LA function can predict the development of HF in older adults without a history of cardiovascular events. Methods and Results: Seven hundred ninety-five participants from a triethnic (white, Black, Hispanic) community-based cohort of adults age >= 55 without a history of cardiovascular events underwent standard, three-dimensional, and speckle-tracking echocardiography. Left atrial volumes, LA strain, LA stiffness, and LA coupling index (LACI) were measured. Longitudinal follow-up was conducted, and new-onset HF was as- certained through standardized interviews, in-person visits, and active hospital surveillance of admission and discharge ICD-9 codes. Risk analysis with a cause-specific hazards regression model was used to assess the association of LA variables with incident HF, adjusting for other HF risk factors. The mean age was 70.9 6 9.2 years (297 men, 498 women). During a mean follow-up of 11.4 years, new-onset HF occurred in 345 partici- pants (43.4%). All measures of LA morphology and function were associated with incident HF (all P < .05). In multivariable analysis, LA stiffness and LACI (adjusted hazard ratio = 2.06; 95% CI, 1.08-3.94; adjusted hazard ratio = 1.25; 95% CI, 1.09-1.43, respectively) remained associated with incident HF. After further adjustment for left ventricular global longitudinal strain, only LACI remained associated with incident HF (adjusted hazard ratio = 1.22; 95% CI, 1.05-1.42). Conclusions: Left atrial coupling index is a stronger independent predictor for incident HF in older adults than LA volumes and strain and may improve HF risk stratification. (J Am Soc Echocardiogr 2025;38:103-10.)