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Anatomical Reconstructions of the Human Cardiac Venous System using Contrast-computed Tomography of Perfusion-fixed Specimens
Published on: April 18, 2013
Early cardio-renal interactions among apparently healthy individuals undergoing coronary CT
Zach Rozenbaum1, Lilian Atlan2, Philippe Taieb3
1Department of Cardiology, Tel Aviv Medical Center, Israel; Affiliated to the Sackler faculty of Medicine, Tel Aviv University, Israel.
Insights
Even in healthy individuals, declining kidney function (estimated glomerular filtration rate or eGFR) is linked to larger left atrial volumes. Early detection and management of factors contributing to this cardio-renal interaction are crucial.
Area of Science:
- Cardiology
- Nephrology
- Radiology
Background:
- Previous research indicated a correlation between cardiac chamber volumes and estimated glomerular filtration rate (eGFR) in hospitalized patients.
- The current study aimed to investigate this relationship in apparently healthy individuals.
Purpose of the Study:
- To determine if reduced kidney function, even within the normal range, is associated with changes in cardiac chamber volumes in healthy adults.
- To explore the association between eGFR and left atrial volume index (LAVI) in a cohort free from significant renal impairment or cardiovascular risk factors.
Main Methods:
- Eighty-nine apparently healthy ambulatory participants underwent electrocardiography-gated cardiac computed tomography angiography (CCTA).
- Exclusion criteria included eGFR < 60 ml/min/1.73m², cardiovascular risk factors, and relevant comorbidities or medications.
- Cardiac chamber volumes were quantified using automated volumetric analysis, and coronary artery calcium scores were calculated.
Main Results:
- Renal function (eGFR) was significantly associated exclusively with left atrial (LA) volume after adjusting for baseline characteristics.
- A 15.9% increase in left atrial volume index (LAVI) was observed in individuals with eGFR of 80-90 ml/min/1.73m² compared to those with eGFR >90 ml/min/1.73m².
- In participants with a low calcium score, reduced eGFR from >90 to 70-80 ml/min/1.73m² led to a significant 24.7% increase in LAVI.
Conclusions:
- Kidney function is closely related to left atrial volume, even in the absence of overt renal failure, indicating minor eGFR changes can increase cardiac volumes.
- These findings highlight the early stages of cardio-renal interaction and suggest the need for identifying and treating contributing risk factors to prevent cardio-renal syndrome.
Background:
Previously we found that cardiac chambers' volumes correlate with estimated glomerular filtration rate (eGFR) of hospitalized patients. Currently we aimed to demonstrate this relation among apparently healthy individuals.
Methods:
Ambulatory participants who underwent electrocardiography-gated cardiac computed tomography angiography (CCTA) were included. Subjects with an eGFR<60 ml/min/1.73m2, cardiovascular risk factors, and co-morbidities or medications which may influence cardiac chambers' volumes were excluded. Chambers' sizes were obtained by automatic four chamber volumetric analysis of the CCTAs, and calcium score was assessed using the Agatston score.
Results:
The cohort consisted of 89 apparently healthy individuals, mostly of male gender (70%), with a mean age of 51 years and a mean eGFR of 79.5 ml/min/1.73m2. A low calcium score (≤10HU) was found in 67.4%(n = 60) of the cohort. After adjustment for baseline characteristics, renal function was associated exclusively with the volume of the left atrium (LA; b-coefficient-0.15, 95%CI -0.3- -0.01, p = .041). A 15.9% (95%CI 0.3-33.9%, p = .045) increase in LA volume index (LAVI) was found among participants with eGFR of 80-90 when compared to those with eGFR>90 ml/min/1.73m2. Participants with a low calcium score showed an increase in LAVI only when eGFR was reduced from normal (>90 ml/min/1.73m2) to 70-80 ml/min/1.73m2 (and not to 80-90 ml/min/1.73m2), revealing a percentage increase of 24.7% (95%CI 5.5-47.4%, p = .011).
Conclusions:
Renal function is closely related to LA volume even in the absence of overt renal failure, demonstrating that minor changes in eGFR instigate an increase in volumes. Risk factors for this interaction should be identified and treated prior to the development of cardio-renal syndrome.
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