Left atrial (LA) enlargement predicts adverse cardiovascular events in patients with
chronic kidney disease (CKD). The aim of our study was to evaluate the value of LA
reservoir strain, a novel measure of LA function, as a prognostic marker for adverse
renal outcomes. A total of 280 patients (65.8 ± 12.2years, 63% male) with stable Stage
3 and 4 CKD without prior cardiac history were evaluated with transthoracic echocardiography
and prospectively followed for up to 5 years. The primary end point was progressive
renal failure, which was the composite of death from renal cause, end-stage renal
failure and/or doubling of serum creatinine. Over a mean follow up of 3.9 ± 2.7years,
56 patients reached the composite endpoint. By log rank test, older age, lower baseline
eGFR, anemia, diabetes mellitus, higher urinary albumin/creatinine ratio, number of
antihypertensive medications, higher indexed left ventricular mass, larger LA volumes,
and impaired LA reservoir strain were significant predictors of the composite outcome
(p <0.01 for all). Multi-variable Cox regression analysis found LA reservoir strain,
eGFR, number of antihypertensive medications and urinary albumin/creatinine ratio
were independent predictors for progressive renal failure (p <0.01 for all). Impaired
LA reservoir strain was associated with a 2.5-fold higher risk of the composite outcome
(HR 2.51, 95% CI 1.19 to 5.30, p = 0.02) and was the only echocardiographic parameter
that predicted progressive renal failure independent of established clinical risk
factors for end-stage renal failure. Its utility requires validation in high risk
CKD patients with cardiac disease.
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Article info
Publication history
Published online: May 25, 2021
Received in revised form:
March 22,
2021
Received:
January 10,
2021
Footnotes
Funding: Dr. Gary C.H. Gan is supported byUniversity of New South Wales Postgraduate Award (UNSW3080080) and the Research and Education Network of the Western Sydney Local Health District Early Investigator Grant (REN 368010)
Data Availability Statement: The data underlying this article will be shared on reasonable request to the corresponding author.
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