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Prognostic value of left atrial size in chronic kidney disease
Mark Y Chan1, Hwee-Bee Wong, Hean-Yee Ong
1The Heart Institute, National University Hospital, Singapore.
Insights
In patients with chronic kidney disease (CKD), increased left atrial (LA) diameter is a strong predictor of cardiovascular disease (CVD) mortality, independent of stress imaging results. This simple measurement can aid risk stratification.
Area of Science:
- Cardiology
- Nephrology
- Medical Imaging
Background:
- Patients with chronic kidney disease (CKD) face elevated cardiovascular disease (CVD) risk.
- Stress imaging is used for CVD risk estimation in CKD patients, but the added value of combined imaging is unclear.
Purpose of the Study:
- To evaluate the incremental value of combinatorial cardiac imaging in predicting CVD mortality in patients with CKD.
- To determine if transthoracic echocardiography and stress single-photon emission computed tomography (SPECT) improve risk prediction in this population.
Main Methods:
- 200 CKD patients (creatinine clearance <60 mL/min) without prior coronary heart disease underwent echocardiography and stress SPECT.
- Follow-up duration was 3.7 years, during which cardiovascular disease (CVD) mortality was recorded.
Main Results:
- 25 CVD deaths occurred during follow-up.
- Univariate analysis showed older age, abnormal SPECT, and increased indexed left atrial (LA) diameter predicted CVD mortality.
- Multivariable analysis revealed indexed LA diameter >24 mm/m² independently predicted CVD mortality (HR 2.75), while abnormal SPECT did not.
Conclusions:
- Indexed LA diameter is an independent predictor of CVD mortality in CKD patients.
- This simple echocardiographic measurement offers prognostic value beyond stress SPECT.
- Indexed LA diameter should be considered a prognostic tool for cardiovascular risk in CKD.
Aims:
Patients with chronic kidney disease (CKD) have high cardiovascular risk. Although stress imaging provides accurate risk estimation in this population, it is unknown if combinatorial cardiac imaging adds incremental value.
Methods And Results:
We performed transthoracic echocardiography and stress single photon emission computed tomography (SPECT) to assess their value in predicting late cardiovascular disease (CVD) mortality in 200 patients with creatinine clearance <60 mL/min without a history of coronary heart disease. During a median follow-up duration of 3.7 (3.5-4.0) years, there were 25 deaths because of CVD. Older age, abnormal SPECT, and increased indexed left atrial (LA) diameter were associated with CVD mortality on univariate analysis with P = 0.007, 0.01, and 0.004, respectively. In multivariable analysis, indexed LA diameter >24 mm/m(2) was independently predictive of CVD mortality [hazard ratio (HR) 2.75, confidence interval (CI) 1.14-6.59], but abnormal SPECT was not. Each mm/m(2) increase in indexed atrial diameter was associated with an HR 1.20 (95% CI 1.06-1.37).
Conclusions:
In patients with CKD, the indexed LA diameter predicts CVD mortality independent of an abnormal SPECT result. Consideration should be given to this simple measurement as a prognostic tool in this population.
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