RT Journal Article SR Electronic T1 Prognostic value of reduction in left atrial size during a follow-up of heart failure: an observational study JF BMJ Open JO BMJ Open FD British Medical Journal Publishing Group SP e044409 DO 10.1136/bmjopen-2020-044409 VO 11 IS 2 A1 Masayuki Shiba A1 Takao Kato A1 Takeshi Morimoto A1 Hidenori Yaku A1 Yasutaka Inuzuka A1 Yodo Tamaki A1 Neiko Ozasa A1 Yuta Seko A1 Erika Yamamoto A1 Yusuke Yoshikawa A1 Takeshi Kitai A1 Yugo Yamashita A1 Moritake Iguchi A1 Kazuya Nagao A1 Yuichi Kawase A1 Takashi Morinaga A1 Mamoru Toyofuku A1 Yutaka Furukawa A1 Kenji Ando A1 Kazushige Kadota A1 Yukihito Sato A1 Koichiro Kuwahara A1 Takeshi Kimura A1 , YR 2021 UL http://bmjopen.bmj.com/content/11/2/e044409.abstract AB Objective The association between sequential changes in left atrial diameter (LAD) and prognosis in heart failure (HF) remains to be elucidated. The present study aimed to investigate the link between reduction in LAD and clinical outcomes in patients with HF.Design A multicentre prospective cohort study.Setting This study was nested from the Kyoto Congestive Heart Failure registry including consecutive patients admitted for acute decompensated heart failure (ADHF) in 19 hospitals throughout Japan.Participants The current study population included 673 patients with HF who underwent both baseline and 6-month follow-up echocardiography with available paired LAD data. We divided them into two groups: the reduction in the LAD group (change <0 mm) (n=398) and the no-reduction in the LAD group (change ≥0 mm) (n=275).Primary and secondary outcomes The primary outcome measure was a composite of all-cause death or hospitalisation for HF during 180 days after 6-month follow-up echocardiography. The secondary outcome measures were defined as the individual components of the primary composite outcome measure and a composite of cardiovascular death or hospitalisation for HF.Results The cumulative 180-day incidence of the primary outcome measure was significantly lower in the reduction in the LAD group than in the no-reduction in the LAD group (13.3% vs 22.2%, p=0.002). Even after adjusting 15 confounders, the lower risk of reduction in LAD relative to no-reduction in LAD for the primary outcome measure remained significant (HR 0.59, 95% CI 0.36 to 0.97 p=0.04).Conclusion Patients with reduction in LAD during follow-up after ADHF hospitalisation had a lower risk for a composite endpoint of all-cause death or HF hospitalisation, suggesting that the change of LAD might be a simple and useful echocardiographic marker during follow-up.