Usefulness of Left Atrial Strain to Predict End Stage Renal Failure in Patients With Chronic Kidney Disease
Section snippets
Methods
This was a prospective multicenter cohort study with longitudinal outcome evaluation. CKD patients with Stage 3 (eGFR 30 to 59 mL/min/1.73 m2) and Stage 4 (eGFR 15 to 29 mL/min/1.73m2) disease attending outpatient nephrology clinics across 2 tertiary hospitals in Western Sydney between 2011 and 2017 were prospectively screened for eligibility. Inclusion criteria were stable renal function, defined as an average change in eGFR of < 5% over the 3 months prior to enrolment, and absent cardiac
Results
A total of 1989 consecutive CKD patients attending the outpatient nephrology clinics were screened of which 792 met the inclusion criteria. Exclusions included 498 patients with previous cardiac history apparent at screening, and an additional 14 patients were excluded following their initial cardiac assessment (Figure 1). Of the 280 patients that comprised the study cohort, 71% of patients had Stage 3 and 29% had Stage 4 CKD. The mean age was 65.8 ± 12.2 years and 63% were male.
Vascular risk
Discussion
Our study demonstrates the prognostic value of LA strain as an independent predictor of progression of renal dysfunction in stable Stage 3/4 CKD patients without previous cardiac history and stable renal function. LA strain was the only echocardiographic parameter that predicted progressive renal failure and was independent of traditional clinical determinants including baseline eGFR, number of anti-hypertensive agents, and urinary albumin/creatinine ratio on multivariate analysis. Other
Authors’ Contribution
Gary C.H. Gan: conceptualization, methodology, investigation, formal analysis, validation, writing – original draft, writing – review and editing, funding acquisition. Aditya Bhat: investigation, formal analysis, validation, writing – original draft, writing – review and editing. Krishna K. Kadappu: investigation, writing – review and editing. Fernando Fernandez: investigation, resources. Kennith H. Gu: investigation. Henry H.L. Chen: investigation, writing – original draft, visualisation.
Disclosures
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Acknowledgment
We would like to acknowledge Dr. S. T. Spicer, Dr. G Suryanarayanan and A/Prof L. Kairaitis from the nephrology departments of Liverpool Hospital, Blacktown Hospital and Westmead Hospital for their support and assistance with recruitment of subjects. We would also like to thank Dr. Karen Byth from the Biostatistics Unit of the Research and Education Network of the Western Sydney Local Health District for her advice and input with our statistical analysis. Lastly, our study would also not have
References (30)
- et al.
A systematic review finds prediction models for chronic kidney disease were poorly reported and often developed using inappropriate methods
J Clin Epidemiol
(2013) - et al.
Mitral peak Doppler E-wave to peak mitral annulus velocity ratio is an accurate estimate of left ventricular filling pressure and predicts mortality in end-stage renal disease
J Am Soc Echocardiogr
(2006) - et al.
Association of left atrial volume with mortality among ESRD patients with left ventricular hypertrophy referred for kidney transplantation
Am J Kidney Dis
(2010) - et al.
Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging
J Am Soc Echocardiogr
(2016) - et al.
Normal ranges of left atrial strain by speckle-tracking echocardiography: a systematic review and meta-analysis
J Am Soc Echocardiogr
(2017) - et al.
Left atrial strain is the best predictor of adverse cardiovascular outcomes in patients with chronic kidney disease
J Am Soc Echocardiogr
(2021) - et al.
Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults: recommendations from the American Society of Echocardiography
J Am Soc Echocardiogr
(2019) - et al.
Association of decreased left atrial strain and strain rate with stroke in chronic atrial fibrillation
J Am Soc Echocardiogr
(2011) - et al.
Independent echocardiographic markers of cardiovascular involvement in chronic kidney disease: the value of left atrial function and volume
J Am Soc Echocardiogr
(2016) - et al.
Relation of elevated C-reactive protein and interleukin-6 levels to left atrial size and duration of episodes in patients with atrial fibrillation
Am J Cardiol
(2005)
Structural and functional remodeling of the left atrium: clinical and therapeutic implications for atrial fibrillation
J Am Coll Cardiol
Risk prediction models for patients with chronic kidney disease
Ann Intern Med
Peak left atrial strain as a single measure for the non-invasive assessment of left ventricular filling pressures
Int J Cardiovasc Imaging
Diastolic dysfunction is an independent predictor of cardiovascular events in incident dialysis patients with preserved systolic function
PLoS One
Value of left atrial strain: a highly promising field of investigation
Eur Heart J Cardiovasc Imaging
Cited by (4)
Interrelation between heart failure with preserved ejection fraction and renal impairment
2022, Reviews in Cardiovascular Medicine
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.