Cardiac magnetic resonance assessment of cardiac function across chronic kidney disease stages

Cardiovascular disease prevalence remains high among chronic kidney disease (CKD) patients. Mechanisms and treatments to improve prognosis remain of paramount importance, and imaging biomarkers of left ventricular myocardial structure and function have better defined the phenotype of renal cardiomyopathy. The left atrial function and right heart remain are less well reported in CKD. This study used cardiac magnetic resonance imaging (CMR) to assess the interplay of left atrial and right ventricular function.

In a cross-sectional study, we examined 58 CKD patients (Group I: stages 2-3, n = 25; Group II: stages 4-5, n = 33). Additionally, 26 age-matched healthy controls were included. Comprehensive CMR protocols (1.5T) were employed, encompassing cine imaging, native T1 and T2 mapping, and tissue tracking strain analysis. Left ventricular (LV), right ventricular (RV) and left atrial (LA) structure, function and strain parameters were assessed.

Compared with healthy controls, both Groups I and II exhibited impaired RV and LA function. right ventricular end-diastolic volume index and right ventricular end-systolic volume index showed significant increases in both Groups I and II (P < .001). All LV, RV and LA strain parameters were reduced in the patient groups (all P < .001). In the univariate binary logistic regression, several parameters, including age, blood pressure, RV volumes and LV/RV strain, were found to have a statistically significant association with CKD. In a multivariable model adjusted for other confounders, RV GLS and left atrial strain remained as independent significant predictors.

RV size, LA strain and volume assessed by CMR serve as markers of RV and LA cardiac dysfunction in CKD patients with preserved LVEF. Greater attention should be given to RV and LA dysfunction for early identification of cardiac dysfunction in CKD patients.