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Correlation of Left Atrial Volume Index with Estimated Glomerular Filtration Rate in Chronic Kidney Disease: A
Abdoulhamid Bagheri1, Sepideh Jame Bozorgi1, Masoume Hesabi Hesari1
1Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Insights
Left atrial volume index (LAVi) and other echocardiographic measures strongly correlate with declining kidney function in chronic kidney disease (CKD) patients. These non-invasive markers can rapidly assess CKD progression and cardiovascular risk.
Area of Science:
- Cardiology
- Nephrology
- Medical Imaging
Background:
- Chronic kidney disease (CKD) is linked to progressive left heart remodeling, including left atrial enlargement and diastolic dysfunction.
- Hemodynamic stress and inflammation in CKD contribute to adverse cardiac changes.
- Rapid assessment of renal function decline is crucial, especially in emergency settings.
Purpose of the Study:
- To evaluate the correlation between estimated glomerular filtration rate (eGFR) and key left heart echocardiographic parameters in CKD stages 2-4.
- To assess the utility of these echocardiographic parameters as rapid, non-invasive predictors of renal function decline.
- To explore their role in cardio-renal risk stratification.
Main Methods:
- A cross-sectional study involving 100 CKD patients (eGFR < 60 mL/min/1.73 m²) without atrial fibrillation or reduced LVEF.
- Transthoracic echocardiography was performed to measure left atrial volume index (LAVi), E/e' ratio, and atrial filling parameters.
- eGFR was calculated using the CKD-EPI formula, and statistical analyses included correlation and ROC curve analysis.
Main Results:
- A strong inverse correlation was found between eGFR and LAVi (r = -0.92, P < .001).
- Moderate inverse correlations were observed between eGFR and E/e' ratio (r = -0.54, P < .0001).
- LAVi showed excellent discriminatory performance for CKD stages, with high sensitivity and specificity at optimal cutoffs.
Conclusions:
- Echocardiographic parameters like LAVi and E/e' correlate strongly and progressively with eGFR decline in CKD patients.
- These left heart indices provide effective bedside discrimination of CKD stages, independent of laboratory results.
- The findings support the use of these parameters for rapid cardio-renal risk stratification, with a need for multicenter validation.
Introduction:
Chronic kidney disease (CKD) drives progressive left heart remodeling through volume overload, inflammation, and hemodynamic stress, manifesting as left atrial enlargement and diastolic dysfunction. This cross-sectional study evaluated correlations between estimated glomerular filtration rate (eGFR) and left heart echocardiographic parameters-including left atrial volume index (LAVi), E/e' ratio, and atrial filling-related parameters-in CKD stages 2-4 to assess their utility as rapid, non-invasive predictors of renal function decline, particularly in emergency settings without laboratory access.
Methods:
100 consecutive CKD patients (eGFR < 60 mL/min/1.73 m², excluding LVEF < 35%, atrial fibrillation, poor acoustic windows) underwent transthoracic echocardiography (Philips EPIQ CVx) at Modarres Hospital, Tehran (2020-2021). Confirmed left heart parameters included: LAVi (biplane area-length method, indexed to BSA); E/e' ratio (pulsed-wave mitral E-velocity ÷ septal tissue Doppler e'-velocity); atrial filling parameters per ASE guidelines. eGFR calculated via CKD-EPI. Statistical analysis comprised Pearson/Spearman correlations, t-tests/Mann-Whitney U, and ROC curves (SPSS v22, P < .05).
Results:
Mean age 61.1 ± 12.7 years (65 males); eGFR 60.76 ± 14.15 mL/min/1.73 m². Strong inverse correlation: eGFR vs LAVi (r = -0.92, P < .001). Moderate inverse correlations: eGFR vs E/e' (r = -0.54, P < .0001). Atrial filling parameters progressively impaired with CKD advancement. LAVi demonstrated excellent discriminatory performance: AUC 0.98 (95% CI 0.97-1.00) for stage 2 vs 3-4; AUC 0.92 (95% CI 0.86-0.97) for stage 3. Optimal cutoffs: ≥ 30 mL/m² (sens 100%, spec 91.4%); ≥ 41 mL/m² (sens 100%, spec 97.9%). Performance robust across LVEF subgroups.
Conclusion:
LAVi, E/e', and atrial filling parameters exhibit strong, progressive correlations with eGFR decline in CKD, offering excellent bedside discrimination of disease stages independent of laboratory measures. These left heart indices support rapid cardio-renal risk stratification; multicenter longitudinal validation warranted.
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