Background. Two-dimensional speckle tracking evaluation (2D-STE) is a useful tool to evaluate the complexity of atrial function by the analysis of the different phases of atrial deformation and by the combination with Doppler measurements of diastolic function. Aim of the study. To evaluate the role of the left atrial (LA) strain parameters to predict worsening chronic heart failure (CHF). Methods. We enrolled outpatients affected by CHF referred to our heart failure unit. Each patient underwent a medical visit, an electrocardiogram (ECG), and an echocardiographic examination. LA function was assessed by 2D-STE. The three phases of LA strain – i.e. the reservoir (LAr), the conduit (LAcd), and the contraction (LAct) – were evaluated. Moreover, the ratio between LAr and that of septal (LAr/Ees), lateral (LAr/Eel), and septal-lateral (LAr/Eem) E/e’ were evaluated. During follow-up, the worsening of heart failure was evaluated. Results. Two hundred twenty-eight patients were enrolled. During a mean follow-up of 14±7 months, 47 patients showed at least one event related to heart failure worsening (40 hospitalisations, 5 heart transplantations, and 19 cardiovascular deaths). During univariate Cox regression analysis, LAr, LAcd, LAct, LAr/Ees, LAr/Eel, and LAr/Eem were all associated with events related to heart failure worsening, but during multivariate regression analysis, only LAr (HR: 0.94; 95% CI: 0.91–0.98; p: 0.007), LAr/Ees (HR: 0.49; 95% CI: 0.30–0.78; p: 0.002), and LAr/Eem (HR: 0.65; 95% CI: 0.47–0.89; p: 0.008) remained significantly associated with the events. Finally, LASr/Ee’s showed accuracy in predicting outcomes greater than LASr (C-index 0.78 vs. 0.72, respectively). Conclusions. In CHF patients, the measure of the LA reservoir by 2D-STE is independently associated with heart failure worsening, but the accuracy in predicting the events is even greater when the reservoir is combined with the Doppler measures of diastolic function.