Chronic kidney disease is independently associated with alterations in left atrial function

Area of Science:

• Cardiology
• Nephrology
• Medical Imaging

Background:

• Chronic kidney disease (CKD) significantly increases cardiovascular risks.
• Early detection of cardiovascular involvement in CKD is crucial for preventing adverse events.
• Left atrial (LA) dysfunction is noted in end-stage renal disease, but data on early CKD stages is limited.

Purpose of the Study:

• To evaluate biplane LA volume and function (global systolic strain [GS] and strain rate [SR]) in stage 3 CKD patients.
• To determine if LA function parameters are more significantly altered by CKD than by hypertension alone.
• To assess LA parameters as sensitive noninvasive tools for cardiovascular involvement in CKD.

Main Methods:

• Compared 33 stage 3 CKD patients with hypertension to 33 normal controls and 34 hypertensive subjects.
• Utilized transthoracic echocardiography to measure indexed biplane LA volume (LAVI), LA segmental function, GS, and SR.
• Employed logistic regression analysis to examine the independent effect of CKD on LA parameters.

Main Results:

• Indexed LA volume (LAVI) was increased in hypertensive and CKD groups compared to controls, but similar between hypertensive and CKD groups.
• LA GS and SR were reduced in both hypertensive and CKD groups compared to controls.
• Significantly lower LA GS was observed in the CKD group (25.7±9.3%) compared to hypertensive (34.5±6.2%) and control groups (54.9±14.5%).
• CKD independently affected LA GS and SR, with GS correlating with blood pressure, diastolic grade, E' velocity, A velocity, and LAVI.

Conclusions:

• Left atrial dysfunction and enlargement are evident in stage 3 CKD.
• LA global systolic strain (GS) and strain rate (SR) are reduced in CKD patients, even with similar LA volumes compared to hypertensive patients.
• LA GS and SR may serve as more sensitive noninvasive markers for detecting cardiovascular involvement in CKD.