Related Experiment Video
Updated: Jun 19, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Assessment of left atrial function provides incremental value: the left atrial volumetric/mechanical coupling index
Liqin Ji1, Xue Gao1, Weiwei Xiao1
1Guizhou Medical University, Guiyang, Guizhou, China.
Insights
The left atrial volumetric/mechanical coupling index (LACI) shows promise for assessing heart function in chronic kidney disease (CKD) patients. A LACI greater than 5.0 independently predicts heart failure risk in this population.
Area of Science:
- Cardiology
- Nephrology
- Biomedical Engineering
Background:
- Heart failure is a significant complication in chronic kidney disease (CKD).
- Left atrial (LA) function is implicated in heart failure development, but its assessment is complex.
- Existing LA parameters lack a single definitive measure, highlighting the need for novel indices like LACI.
Purpose of the Study:
- To define the left atrial volumetric/mechanical coupling index (LACI) in a CKD cohort.
- To evaluate LACI's utility in assessing LA function.
- To determine LACI's predictive value for heart failure in CKD patients.
Main Methods:
- Enrolled a cohort of CKD patients between 2021-2023 with follow-up for heart failure.
- Calculated LACI as the ratio of LA volume index to atrial contraction velocity.
- Utilized correlation analyses, ROC curves, and regression models to assess LACI's association with echocardiographic/hemodynamic variables and heart failure prediction.
Main Results:
- LACI positively correlated with NT-proBNP, CK-MB, LAVI, E/e', and LASI; negatively with LASr.
- LACI's area under the curve (AUC) for heart failure detection was comparable to other LA parameters.
- Elevated LACI (>5.0) was associated with increased cardiovascular risk factors and independently predicted a higher risk of heart failure (OR: 0.121, p=0.022).
Conclusions:
- LACI demonstrates potential as a valuable tool for LA function assessment in CKD.
- LACI may aid in the prognostic evaluation and clinical decision-making for CKD patients.
- Integration of LACI into routine LA assessment could improve patient management.
Background:
Heart failure is a common cause of adverse cardiovascular outcomes in patients with chronic kidney disease (CKD). Left atrial (LA) characteristics are thought to be involved in the development of heart failure. However, LA assessment is complex. Though a variety of parameters have been defined, there is no single parameter that best defines LA function. Pilot data indicate that left atrial volumetric/mechanical coupling index (LACI) may be useful, but data with CKD are lacking.
Aim:
The objective of this study was to define LACI in a cohort of patients with CKD and to assess its value in evaluating LA function and predicting heart failure.
Methods:
A cohort of patients with CKD was enrolled at our hospital between 2021 and 2023. Follow-up was performed for heart failure. LACI is a volumetric to mechanical coupling index, calculated as the ratio of the LA volume index to the tissue-Doppler myocardial velocity at atrial contraction. Spearman's rank correlation or Pearson's correlation was used to calculate the correlation between LACI and echocardiographic/hemodynamic variables. Receiver operating characteristic curve (ROC) analysis was utilised to derive the area under the curve (AUC) for LACI, LVGLS, LASr, LASct and LASI for the detection of heart failure. Kaplan-Meier survival curves were employed to compare clinical outcomes based on LACI thresholds. A multivariable logistic regression analysis was employed to assess the relationship between risk factors and elevated LACI. Cox proportional hazards regression was used to identify risk factors for heart failure.
Results:
LACI showed a positive correlation with NT-proBNP, CK-MB, LAVI, E/e' and LASI (r = 0.504, 0.536, 0.856, 0.541 and 0.509, p < 0.001); and a negative correlation with LASr (r = -0.509, p < 0.001). On the ROC analysis for the determination of heart failure, the AUC of LACI was comparable to those of LVGLS (0.588 vs. 509, p = 0.464), LASr (0.588 vs. 0.448, p = 0.132), LASct (0.588 vs. 0.566, p = 0.971) and LASI (0.588 vs. 0.570, p = 0.874). The cardiovascular risk factors increased by LACI were age, BMI, diabetes, triglycerides, LA size, LASr, LASI, E/A, E/e' and EF (p < 0.05). During a median follow-up of 16 months (range, 6-28 months), the event-free survival curves demonstrated a higher risk of heart failure in the group with LACI > 5.0 (log-rank test: P < 0.001). LACI > 5.0 was an independent predictor of heart failure [OR: 0.121, 95% CI (0.020-0.740), p = 0.022].
Conclusion:
LACI may prove to be a valuable tool for assessing LA function in patients with CKD, and could be integrated into the routine assessment of LA for the purpose of prognostic assessment and clinical decision-making in patients with CKD.
