LEFT ATRIAL STRAIN AN EARLY MARKER OF FUTURE ADVERSE CARDIOVASCULAR EVENTS IN CHRONIC KIDNEY DISEASE

Abstract Funding Acknowledgements Nil Background and objectives Patients with chronic kidney disease (CKD) are at increased risk of adverse cardiovascular events that are underestimated by traditional risk stratification algorithms. We sought to determine clinical and echocardiographic predictors of adverse outcomes in CKD patients. Methods Stage 3 and 4 CKD patients without previous cardiac disease underwent a comprehensive transthoracic and stress echocardiogram, with left ventricular (LV) and left atrial (LA) strain analysis. Participants were followed for the primary end point of a composite of all-cause death and major adverse cardiovascular events (MACE). The secondary end point was a composite of cardiovascular death and MACE. Results 243 patients (male 63%; mean age 59.2 ± 14.4 years) were followed for a median of 3.9 ± 2.7 years. 69 patients met the primary endpoint and 58 the secondary end point. Age (p < 0.01), history of diabetes mellitus (p < 0.01), indexed LV mass(LVMI) (p < 0.01), LV global longitudinal strain(GLS) (p < 0.01), indexed LA volume(LAVI) (p < 0.01), E/e’ ratio (p < 0.01) and LA strain (LAs) (p < 0.01) were independent predictors of death and MACE. On Cox proportional hazards regression analysis, LAs (p < 0.01) was the only independent predictor for the primary end point in a model accounting for age, diabetes mellitus, LVMI, LVGLS, E/e’ and LAVI. LAs remained an independent predictor for the secondary end point. Conclusions LAs is an independent predictor of death and MACE in CKD patients, in whom the predominant cardiac abnormality is diastolic impairment. LAs is a prognostic biomarker, reflecting alterations in diastolic function in CKD. Abstract P1709 Figure. Kaplan Meier curve of LAs

Download Full-text

Left atrial strain - an early marker of left ventricular diastolic dysfunction in patients with hypertension and paroxysmal atrial fibrillation

Cardiovascular Ultrasound ◽

10.1186/s12947-018-0147-6 ◽

2018 ◽

Vol 16 (1) ◽

Cited By ~ 9

Author(s):

Jonas Jarasunas ◽

Audrius Aidietis ◽

Sigita Aidietiene

Keyword(s):

Atrial Fibrillation ◽

Diastolic Dysfunction ◽

Paroxysmal Atrial Fibrillation ◽

Left Atrial ◽

Left Ventricular Diastolic Dysfunction ◽

Left Ventricular ◽

Left Atrial Strain ◽

Early Marker ◽

Ventricular Diastolic Dysfunction ◽

Atrial Strain

Download Full-text

A Systematic Review on the Correlations between Left Atrial Strain and Cardiovascular Outcomes in Chronic Kidney Disease Patients

Diagnostics ◽

10.3390/diagnostics11040671 ◽

2021 ◽

Vol 11 (4) ◽

pp. 671

Author(s):

Ana Tanasa ◽

Alexandru Burlacu ◽

Cristina Popa ◽

Mehmet Kanbay ◽

Crischentian Brinza ◽

...

Keyword(s):

Diastolic Dysfunction ◽

Left Atrial ◽

Cardiovascular Events ◽

Cardiovascular Outcomes ◽

Major Adverse Cardiovascular Events ◽

Function Evaluation ◽

Cochrane Central Register ◽

Left Atrial Strain ◽

Atrial Strain ◽

The Impact

Left atrial strain (LASr) represents a relatively new but promising technique for left atrial and left ventricle function evaluation. LASr was strongly linked to myocardial fibrosis and endocardial thickness, suggesting the utility of LASr in subclinical cardiac dysfunction detection. As CKD negatively impacts cardiovascular risk and mortality, underlying structural and functional abnormalities of cardiac remodeling are widely investigated. LASr could be used in LV diastolic dysfunction grading with an excellent discriminatory power. Our objectives were to assess the impact and existing correlations between LASr and cardiovascular outcomes, as reported in clinical trials, including patients with CKD. We searched PubMed, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials for full-text papers. As reported in clinical studies, LASr was associated with adverse cardiovascular outcomes, including cardiovascular death and major adverse cardiovascular events (HR 0.89, 95% CI, 0.84–0.93, p < 0.01), paroxysmal atrial fibrillation (OR 0.847, 95% CI, 0.760–0.944, p = 0.003), reduced exercise capacity (AUC 0.83, 95% CI, 0.78–0.88, p < 0.01), diastolic dysfunction (p < 0.05), and estimated pulmonary capillary wedge pressure (p < 0.001). Despite limitations attributed to LA deformation imaging (image quality, inter-observer variability, software necessity, learning curve), LASr constitutes a promising marker for cardiovascular events prediction and risk evaluation in patients with CKD.

Download Full-text