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Published on: February 26, 2013
Left Atrial Volume as a Biomarker of Target Organ Damage in Cardionephrology: A Study in a Wide Range of Renal
Zach Rozenbaum1, Orit Kliuk Ben-Bassat2, Yitzhak Hadad3
1Department of Cardiology, Tel Aviv Medical Center (affiliated with the Sackler Faculty of Medicine, Tel Aviv University), Tel Aviv, Israel.
Insights
Cardiac chamber volumes correlate with kidney function across all ranges, particularly the left atrium. This early indicator may help identify cardiorenal syndrome for timely intervention.
Area of Science:
- Cardiology
- Nephrology
- Radiology
Background:
- Previous studies on cardiac chamber size and kidney disease were limited to echocardiography in patients with advanced kidney disease.
- This study broadens the scope to include all cardiac chambers and explore their relationship with renal function across a wider spectrum.
Purpose of the Study:
- To investigate the association between cardiac chamber volumes, assessed via CT pulmonary angiography, and estimated glomerular filtration rates (eGFR).
- To determine if renal function impacts heart chamber dimensions even within normal ranges.
Main Methods:
- Utilized automatic four-chamber volumetric analysis on CT pulmonary angiography data from 748 patients without pulmonary embolism.
- Correlated cardiac chamber volumes (indexed to body surface area) with eGFR.
Main Results:
- All cardiac chamber volumes, except the left ventricle, inversely correlated with eGFR after age adjustment.
- A 10-unit decrease in eGFR was associated with increased left atrium (3.1%), right atrium (2.3%), and right ventricle (1.5%) volume indices.
- Left atrial volume index showed a significant inverse correlation with eGFR (r = -0.43, P < .001).
- Patients with minimal renal dysfunction (eGFR 60-90 mL/min/1.73 m²) had a 10.3% larger left atrial volume index compared to those with eGFR > 90 mL/min/1.73 m².
Conclusions:
- CT pulmonary angiography enables volumetric analysis of all cardiac chambers, revealing correlations with renal function across the entire spectrum.
- The left atrium demonstrated the most significant changes, suggesting it as an early indicator of evolving cardiorenal syndrome.
- These findings may guide early therapeutic interventions for cardiorenal syndrome.
Background:
Cardiac chamber size was previously studied by echocardiography, among patients with progressive kidney disease only. We aimed to explore the relations between all heart chamber volumes as assessed by CT pulmonary angiography and renal function, throughout all ranges.
Methods:
Using a novel technology for automatic four-chamber volumetric analysis, we analyzed CT pulmonary angiography results for 748 consecutive patients (between January 1 and December 31, 2014) without pulmonary embolism, and correlated the chamber volumes, indexed to body surface area, with the estimated glomerular filtration rates (eGFRs).
Results:
After adjustment for age, all cardiac chamber volumes aside from that of the left ventricle inversely correlated with the eGFR. For every 10-unit decrease in eGFR, the volume indices of the left atrium, right atrium, and right ventricle were larger by 3.1%, 2.3%, and 1.5% (P < .001, P = .003, P = .007), respectively. There was a significant correlation between left atrial volume index and eGFR (r = -0.43; P < .001). In a categorical comparison, patients with even minimal renal dysfunction (eGFR, 60 to 90 mL/min/1.73 m2) had a 10.3% larger left atrial volume index (95% CI, 3.1-17.9; P = .004) compared to patients with an eGFR > 90 mL/min/1.73 m2.
Conclusions:
A simple concomitant volumetric analysis of all four cardiac chambers by CT pulmonary angiography demonstrated that differences in volume correlate with renal function even within the normal range spectrum. The difference was most evident in the left atrium. This finding may be the first clue to evolving cardiorenal syndrome and may serve as a target for early therapeutic interventions.
Trial Registry:
ClinicalTrials.gov; Clinical Trials registration number (Helsinki Committee): 0603-15-TLV; URL: www.clinicaltrials.gov.
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