BACKGROUND: Early prediction of left ventricular reverse remodeling (LVRR) can guide the subsequent treatment in dilated cardiomyopathy (DCM) patients. We aimed to investigate the value of left atrium (LA) strain for predicting LVRR in DCM patients. METHODS: Clinical and imaging data of DCM patients were gather between January 2018 and January 2023. The participators were divided into LVRR group and non-LVRR group according to the ultrasound follow-up results. CMR images were process to yield LA fast long-axis strain parameters. Univariate and multivariate logistic regression analysis was used to screen the predictors and establish the prediction model. RESULTS: The study included 116 participants. LVRR occurred in 69 participants within 1 year. Compared with the non-LVRR group, the LVRR group has smaller left ventricular end-diastolic volume index (LVEDVi), late gadolinium enhancement extent (LGE%) and higher left atrial passive eject fraction (LAPEF), left atrial reservoir strain (LARS) and left atrial conduit strain (LACS). In multivariable logistic regression analysis, LVEDVi (HR: 0.990
95 % CI: 0.981, 0.999
P = 0.037), LACS (HR: 1.434
95 % CI: 1.025, 2.007
P = 0.035) and LGE% (HR: 0.713
95 % CI: 0.584, 0.870
P = 0.001) were independent predictors of LVRR. The model based on NYHA, LVEDVi, LGE% and LACS had a better performance in predicting LVRR (AUC = 0.807
95 % CI: 0.723
0.874). CONCLUSIONS: LVEDVi, LACS and LGE% were independent predictors of LVRR within 1 year in DCM patients. The combination of NYHA, LVEDVi, LACS and LGE% has a better predictive performance.