Left Atrial Volume and Adverse Cardiovascular Outcomes in Unselected Patients with and without CKD

Abstract

Background and objectives Patients with CKD have increased cardiovascular morbidity and mortality. This study investigated the prognostic value of common clinical echocardiographic parameters.Design, setting, participants, & measurements There were 289 unselected consecutive patients who had a transthoracic echocardiogram between January and June 2003. Patients with stage 3 or 4 CKD (n=49) were compared with those with eGFR$60 ml/min per 1.73 m 2 , n=240). Left ventricular volume, ejection fraction and mass, left atrial volume, and function parameters were measured. The primary endpoint, determined a priori, was a composite of cardiac death, myocardial infarction, and congestive cardiac failure.Results Patients were followed for a median 5.6 years. The incidence of the primary endpoint was higher in patients with CKD (29% versus 12%, P=0.001), who were older and had a higher prevalence of hypertension and ischemic heart disease. Indexed left ventricular mass (LVMI) and left atrial volume (LAVI) were higher in patients with CKD. Furthermore, patients with LAVI.32 ml/m 2 had significantly lower event-free survival than patients with normal (,28 ml/m 2 ) or mildly dilated LAVI (28-32 ml/m 2 ) (P,0.001). Multivariate analysis showed that age (odds ratio [OR], 1.19; 95% confidence interval [95% CI], 1.08 to 1.31; P=0.001) and LVMI (OR, 3.66; 95% CI, 2.47 to 5.41; P,0.001) were independently associated with LAVI.32 ml/m 2 . Multivariate Cox regression analysis demonstrated that CKD (hazard ratio [HR], 1.13; 95% CI, 1.01 to 1.26; P=0.04), hypertension (HR, 2.18; 95% CI, 1.05 to 4.54; P=0.04), and a larger LAVI (HR, 1.35; 95% CI, 1.02 to 1.77; P=0.04) were independent predictors of the primary endpoint.Conclusions Patients with CKD were at higher risk for cardiovascular events. LAVI was significantly larger in the CKD group and was a predictor of adverse cardiac events.

Relationship between increased left atrial volume and microvascular complications in patients with type 2 diabetes

“…However, a number of studies have suggested that type 2 diabetes may affect cardiac structure and function, independent of established CVD risk factors, consistent with 2005; Tsang et al, 2003). Again, increased LAVI predicted independently the risk of CVD mortality in patients with acute myocardial infarction (Moller et al, 2003), in those with dilated cardiomyopathy (Rossi et al, 2002), in those with chronic HF and preserved systolic function (Rossi et al, 2006(Rossi et al, , 2014, and in patients with chronic kidney disease (Hee et al, 2014).…”

Left atrial volume in elite athletes: A meta‐analysis of echocardiographic studies

“…Longitudinal studies have consistently demonstrated that LA enlargement, as defined by a single LA diameter, or more accurately, by LA volume (LAV), is a robust predictor of cardiovascular death, stroke, heart failure, myocardial infarction, and new‐onset atrial fibrillation (AF) …”

“…5,6 Longitudinal studies have consistently demonstrated that LA enlargement, as defined by a single LA diameter, or more accurately, by LA volume (LAV), is a robust predictor of cardiovascular death, stroke, heart failure, myocardial infarction, and new-onset atrial fibrillation (AF). 8,9 Enlargement of LA is frequently associated with increased left ventricular mass (LVM) or frank LV hypertrophy (LVH), 11 both changes being commonly observed in pathological conditions characterized by increased blood pressure and LV overload. Also in the context of the so-called athlete's heart, LVH induced by intensive physical training and by sustained exposure to isotonic and/or static exercise has been documented to be paralleled by LA dilatation.…”

NT-proBNP and Echocardiographic Parameters for Prediction of Cardiovascular Outcomes in Patients with CKD Stages G2–G4

“…Natriuretic peptides are independently associated with prevalent cardiovascular disease (CVD) and future CV events in crosssectional (3,4) and prospective (5)(6)(7)(8) CKD cohort studies. In echocardiographic studies, left ventricular (LV) hypertrophy (9)(10)(11) and left atrial enlargement (10,(12)(13)(14)(15)(16) as well as systolic LV (10,17) and diastolic dysfunction (18,19) predicted adverse outcome among patients with CKD.…”