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Association of left atrial volume and function parameters with cardiovascular outcomes following kidney
Ava R DeLonais-Parker1, Spencer H Hobbs1, Taylor R Coffman1
1Saint Louis University School of Medicine, Saint Louis, MO, USA.
Insights
Left atrial (LA) strain parameters, including LA circumferential strain (LAScd) and LA longitudinal strain (LASr), predict major adverse cardiovascular events (MACE) in kidney transplant (KT) recipients. These findings suggest LA strain can aid in risk stratification for KT patients.
Area of Science:
- Cardiology
- Nephrology
- Echocardiography
Background:
- Left atrial (LA) volume and strain are linked to cardiovascular outcomes in various heart conditions.
- The predictive value of LA strain for major adverse cardiovascular events (MACE) in kidney transplant (KT) recipients remains unexplored.
Purpose of the Study:
- To investigate the association between LA strain parameters and MACE in KT recipients.
- To determine if LA strain can serve as a prognostic marker in this patient population.
Main Methods:
- Retrospective analysis of adult KT recipients (2015-2024) with baseline echocardiograms.
- Measurement of LA volumetrics and strain parameters.
- Definition of MACE as cardiovascular death, myocardial infarction, stroke, arrhythmias, or heart failure hospitalization.
- Statistical analysis including logistic regression, Kaplan-Meier, and Cox proportional hazards regression.
Main Results:
- Of 377 eligible KT recipients, 82 experienced MACE during a median follow-up of 5.3 years.
- Kaplan-Meier analysis indicated lower MACE-free survival in patients with abnormal LA strain.
- Lower LA circumferential strain (LAScd) and LA longitudinal strain (LASr) were independently associated with MACE after adjusting for confounders.
Conclusions:
- LA strain parameters, specifically LASr and LAScd, are independently associated with MACE post-KT.
- LA strain shows potential as a tool for risk stratification in kidney transplant recipients.
Purpose:
Left atrial (LA) volume and strain parameters have been associated with cardiovascular outcomes in several cardiac pathologies, yet their role in predicting major adverse cardiovascular events (MACE) in kidney transplant (KT) recipients has not been explored.
Methods:
We retrospectively reviewed the records of adult KT recipients from our institution (2015-2024). We utilized baseline echocardiograms routinely acquired during KT workup to measure LA volumetrics and strain. MACE was the study's primary endpoint, defined as cardiovascular death, nonfatal myocardial infarction, stroke, major arrhythmias or heart failure hospitalization. Logistic regression, Kaplan-Meier and Cox proportional hazards regression were performed to evaluate the association between LA parameters and MACE.
Results:
Of 518 patients who underwent kidney transplant, 377 were in sinus rhythm with an acceptable quality echocardiogram (male, 56.7%; mean age 53.7 ± 13.1 years). Over a median follow up duration of 5.3 ± 2.3 years from KT, 82 patients reached the study endpoint. Kaplan-Meier analysis showed significantly lower MACE-free survival in patients with abnormal LA strain. After adjusting for confounding variables in the Cox Proportional Hazards model, of all LA parameters, lower LAScd (HR 0.94, 95% CI 0.89-0.98, p = 0.003), and LASr (HR 0.97, 95% CI 0.94-0.995, p = 0.02) were independently associated with MACE.
Conclusion:
In this retrospective single center study, LA strain parameters particularly LASr and LAScd were independently associated with MACE after KT. LA strain might have a role in risk stratification in this population.
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