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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Left atrial volume and adverse cardiovascular outcomes in unselected patients with and without CKD
Leia Hee1, Tuan Nguyen2, Melinda Whatmough2
1Cardiology Department, Liverpool Hospital, Sydney, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia;
Insights
Patients with chronic kidney disease (CKD) face higher risks of cardiovascular events. Left atrial volume index (LAVI) is a significant predictor of these adverse cardiac outcomes in CKD patients.
Area of Science:
- Cardiology
- Nephrology
- Clinical Echocardiography
Background:
- Patients with chronic kidney disease (CKD) exhibit elevated cardiovascular morbidity and mortality.
- Echocardiographic parameters may offer prognostic value in this high-risk population.
Purpose of the Study:
- To investigate the prognostic significance of common clinical echocardiographic parameters in patients with CKD.
- To assess the association between echocardiographic findings and adverse cardiovascular events.
Main Methods:
- A cohort of 289 patients underwent transthoracic echocardiography.
- Patients were categorized based on estimated glomerular filtration rate (eGFR) into CKD (stage 3-4) and non-CKD groups.
- Key echocardiographic parameters including left ventricular volume, ejection fraction, mass, and left atrial volume and function were measured.
Main Results:
- The primary endpoint (cardiac death, myocardial infarction, congestive heart failure) occurred more frequently in the CKD group (29% vs. 12%).
- Higher indexed left ventricular mass (LVMI) and left atrial volume index (LAVI) were observed in CKD patients.
- Elevated LAVI (>32 ml/m(2)) was associated with significantly lower event-free survival.
- Multivariate analysis identified CKD, hypertension, and increased LAVI as independent predictors of adverse cardiovascular events.
Conclusions:
- Patients with CKD are at increased risk for adverse cardiovascular events.
- Left atrial volume index (LAVI) is a significant predictor of cardiovascular events in patients with CKD.
Background And Objectives:
Patients with CKD have increased cardiovascular morbidity and mortality. This study investigated the prognostic value of common clinical echocardiographic parameters.
Design, Setting, Participants, & Measurements:
There were 289 unselected consecutive patients who had a transthoracic echocardiogram between January and June 2003. Patients with stage 3 or 4 CKD (n=49) were compared with those with eGFR≥60 ml/min per 1.73 m(2), n=240). Left ventricular volume, ejection fraction and mass, left atrial volume, and function parameters were measured. The primary endpoint, determined a priori, was a composite of cardiac death, myocardial infarction, and congestive cardiac failure.
Results:
Patients were followed for a median 5.6 years. The incidence of the primary endpoint was higher in patients with CKD (29% versus 12%, P=0.001), who were older and had a higher prevalence of hypertension and ischemic heart disease. Indexed left ventricular mass (LVMI) and left atrial volume (LAVI) were higher in patients with CKD. Furthermore, patients with LAVI>32 ml/m(2) had significantly lower event-free survival than patients with normal (<28 ml/m(2)) or mildly dilated LAVI (28-32 ml/m(2)) (P<0.001). Multivariate analysis showed that age (odds ratio [OR], 1.19; 95% confidence interval [95% CI], 1.08 to 1.31; P=0.001) and LVMI (OR, 3.66; 95% CI, 2.47 to 5.41; P<0.001) were independently associated with LAVI>32 ml/m(2). Multivariate Cox regression analysis demonstrated that CKD (hazard ratio [HR], 1.13; 95% CI, 1.01 to 1.26; P=0.04), hypertension (HR, 2.18; 95% CI, 1.05 to 4.54; P=0.04), and a larger LAVI (HR, 1.35; 95% CI, 1.02 to 1.77; P=0.04) were independent predictors of the primary endpoint.
Conclusions:
Patients with CKD were at higher risk for cardiovascular events. LAVI was significantly larger in the CKD group and was a predictor of adverse cardiac events.
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