Left Atrial Strain Is the Best Predictor of Adverse Cardiovascular Outcomes in Patients with Chronic Kidney Disease

Gan, G.; Kadappu, K.; Bhat, A.; Fernandez, F.; Gu, K.; Cai, Lawrence X.; Byth, Karen; Eshoo, S.; Thomas, Liza

doi:10.1016/j.echo.2020.09.015

Cited by 32 publications

(26 citation statements)

References 31 publications

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“…Echocardiography has been shown as a useful tool in the assessment of mortality risk in CKD patients. Gan et al [ 35 ] have demonstrated that impaired left atrial reservoir strain (LASr) is the best predictor of adverse cardiovascular outcomes in CKD stage 3-4 patients. In this assessment, the left atrium is divided into a total of 12 segments: six segments each from the apical four- and two-chamber views.…”

Section: Discussionmentioning

confidence: 99%

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Prediction of mortality among patients with chronic kidney disease: A systematic review

Hansrivijit

Chen

Lnu

et al. 2021

WJN

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BACKGROUND Chronic kidney disease (CKD) is a common medical condition that is increasing in prevalence. Existing published evidence has revealed through regression analyses that several clinical characteristics are associated with mortality in CKD patients. However, the predictive accuracies of these risk factors for mortality have not been clearly demonstrated. AIM To demonstrate the accuracy of mortality predictive factors in CKD patients by utilizing the area under the receiver operating characteristic (ROC) curve (AUC) analysis. METHODS We searched Ovid MEDLINE, EMBASE, and the Cochrane Library for eligible articles through January 2021. Studies were included based on the following criteria: (1) Study nature was observational or conference abstract; (2) Study populations involved patients with non-transplant CKD at any CKD stage severity; and (3) Predictive factors for mortality were presented with AUC analysis and its associated 95% confidence interval (CI). AUC of 0.70-0.79 is considered acceptable, 0.80-0.89 is considered excellent, and more than 0.90 is considered outstanding. RESULTS Of 1759 citations, a total of 18 studies ( n = 14579) were included in this systematic review. Eight hundred thirty two patients had non-dialysis CKD, and 13747 patients had dialysis-dependent CKD (2160 patients on hemodialysis, 370 patients on peritoneal dialysis, and 11217 patients on non-differentiated dialysis modality). Of 24 mortality predictive factors, none were deemed outstanding for mortality prediction. A total of seven predictive factors [N-terminal pro-brain natriuretic peptide (NT-proBNP), BNP, soluble urokinase plasminogen activator receptor (suPAR), augmentation index, left atrial reservoir strain, C-reactive protein, and systolic pulmonary artery pressure] were identified as excellent. Seventeen predictive factors were in the acceptable range, which we classified into the following subgroups: predictors for the non-dialysis population, echocardiographic factors, comorbidities, and miscellaneous. CONCLUSION Several factors were found to predict mortality in CKD patients. Echocardiography is an important tool for mortality prognostication in CKD patients by evaluating left atrial reservoir strain, systolic pulmonary artery pressure, diastolic function, and left ventricular mass index.

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Section: Discussionmentioning

confidence: 99%

“…In this assessment, the left atrium is divided into a total of 12 segments: six segments each from the apical four- and two-chamber views. LASr is measured from the average peak systolic strain from the 12 segments[ 35 ]. Impaired LASr is defined as ≤ 23%, based on a previously reported lower limit of reference value[ 51 ].…”

Section: Discussionmentioning

confidence: 99%

Prediction of mortality among patients with chronic kidney disease: A systematic review

Hansrivijit

Chen

Lnu

et al. 2021

WJN

View full text Add to dashboard Cite

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“…16,18 Fourth, left atrial strain, which reflects the ''true'' myocardial mechanics of the left atrium and might provide additional prognostic information in patients with CKD, was not assessed in the present study. 49 Fifth, pulmonary venous flow, available in only 64% patients, was not used to evaluate DD.…”

Section: Limitationsmentioning

confidence: 99%

Associations between Myocardial Diastolic Dysfunction and Cardiovascular Mortality in Chronic Kidney Disease: A Large Single-Center Cohort Study

Liang

Hsiao

Yeh

et al. 2022

Journal of the American Society of Echocardiography

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“…Our findings imply that successful RT may be associated with an improvement in LA deformation parameters which have been demonstrated to be the best predictor of CV outcomes in patients with CKD [ 35 ]. Among the standard echocardiographic parameters, mitral e’ shows the best correlation with LA deformation parameters, particularly with the ones indicating LA reservoir and conduit function.…”

Section: Discussionmentioning

confidence: 78%

Comparison of left atrial deformation parameters between renal transplant and hemodialysis patients

Yildirim

Akçay

Çoksevim

et al. 2022

Cardiovasc Ultrasound

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Background Renal transplantation (RT) has been demonstrated to improve left ventricular systolic function. However, only few studies have attempted to reveal the effects of transplantation on left atrial (LA) function. In our study, we aimed to compare LA function between RT and hemodialysis patients. Methods This cross-sectional study included 75 consecutive patients with RT, and 75 age- and gender-matched patients on maintenance hemodialysis. LA strain and strain rate (SR) analyzed by two-dimensional (2D) speckle tracking echocardiography (STE) were compared between the groups in addition to standard echocardiographic parameters. Results LA strain during reservoir phase (29.88 ± 5.76% vs 26.11 ± 5.74%, P < .001), LA strain during conduit phase (− 15.28 ± 5.00% vs − 12.92 ± 4.38%, P = .003), and LA strain during contraction phase (− 14.60 ± 3.32% vs − 13.19 ± 3.95%, P = .020) were higher in the transplantation group. Similarly, LA peak SR during reservoir phase (1.54 ± 0.33 s− 1 vs 1.32 ± 0.33 s− 1, P < .001), LA peak SR during conduit phase (− 1.47 ± 0.49 s− 1 vs − 1.12 ± 0.42 s− 1, P < .001), and LA peak SR during contraction phase (− 2.13 ± 0.46 s− 1 vs − 1.83 ± 0.58 s− 1, P = .001) were higher in the transplantation group as well. Conclusions LA function assessed by 2D STE was better in RT patients than hemodialysis patients. This may suggest favorable effects of RT on LA function.

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Left Atrial Strain Is the Best Predictor of Adverse Cardiovascular Outcomes in Patients with Chronic Kidney Disease

Cited by 32 publications

References 31 publications

Prediction of mortality among patients with chronic kidney disease: A systematic review

Prediction of mortality among patients with chronic kidney disease: A systematic review

Associations between Myocardial Diastolic Dysfunction and Cardiovascular Mortality in Chronic Kidney Disease: A Large Single-Center Cohort Study

Comparison of left atrial deformation parameters between renal transplant and hemodialysis patients

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