A look at the upper heart chamber: the left atrium in chronic kidney disease

Abstract

Altered left ventricular (LV) mass and function are classical hallmarks of cardiomyopathy in chronic kidney disease (CKD). The left atrium (LA), a heart chamber exquisitely sensitive to volume overload and diastolic function, is an independent predictor of death and adverse cardiovascular (CV) events in high-risk patients such as those with hypertension and/or with heart failure. In this review we focus on the relationship of LA size with LV diastolic function, and the association between LA enlargement and CV and renal outcomes in patients with CKD, including patients with end-stage renal disease. Increased LA size emerges as a powerful predictor of mortality and major adverse CV events in both end-stage and early CKD, and some studies also show a close association between enlarged LA and renal disease progression. Secondary analyses of clinical trials suggest that the LA has the potential to be elected as a surrogate end point in CKD patients but the issue remains to be tested in specifically designed clinical studies.

Left atrial and ventricular systolic and diastolic myocardial mechanics in patients with end‐stage renal disease

“…The LA dilates when it is exposed to high LV filling pressures over time, and hence can reflect the magnitude and duration of diastolic impairment. In CKD and ESRD, changes in LA volume portend poor prognosis …”

High estimated pulmonary artery systolic pressure predicts adverse cardiovascular outcomes in stage 2–4 chronic kidney disease

“…These findings, which are in keeping with previous studies of PH in dialysis patients, 9,[18][19][20] support the hypothesis that in most cases PH in CKD is postcapillary in nature 21 -i.e., it depends on passive congestion of the venous side of the pulmonary vasculature rather than by an increase in pulmonary artery vascular resistances. Subtle or clinically manifest volume expansion, a hallmark of CKD, together with LV diastolic dysfunction, is a relevant determinant of LAV 22 and therefore may contribute to raised pulmonary pressure in CKD patients.…”

Predictors of acute kidney injury after coronary artery surgery in Jordanians

“…LA size has been shown to be a predictor of mortality and morbidity in many clinical settings. 17,18 MR is associated with low ejection fraction and enlarged atria. 15 In our study, LA size was strongly associated with ARF after CABG, however, it was excluded from the model due to colinearity with MR and ejection fraction.…”