Prognostic Value of Left Atrial Volume Index in End Stage Renal  Disease Patients

Abstract

Introduction: Cardiovascular Disease is the leading cause of death in End Stage Renal Disease patients. Left atrial volume index is an established independent risk predictor for mortality in atherosclerotic heart disease. However, Left atrial volume index has not been extensively studied in hemodialysis population. The aim of this study is to assess the impact of Left atrial volume index on mortality in hemodialysis patients.Methods: This is a descriptive cross sectional study. From January 1, 2013, through April 30, 2018, we evaluated echocardiographic findings of 91 End stage renal disease patients on maintenance hemodialysis. Patient information was collected and data analysed using SPSS version 22 for windows software package. Results :The average age of the patients was 62.85±12.4 years. The average duration of dialysis was 29.54 months as shown in Table 1.The mean Left atrial volume index of our dialysis patients was 38.993 ml/m2. The mean Left atrial volume index of 42.62±10.24 ml/m2 in expired patients as compared to 36.6 ml/m2 in alive patients with a p-value of 0.004 shows that Left atrial volume index of expired patients was significantly higher as compared to alive patients (Table 2).Area under the curve using Receiver operating characteristic curve was found 66.7% which was statistically significant with p-value 0.007, which suggests that the cutoff value of Left atrial volume index for expired patients can be at least 38.5.61.5% patients that expired had a Left atrial volume index of more than 38.5 ml/m2, whereas 62.7% patients that were alive had a Left atrial volume index less than 38.5 ml/m2 , the p-value 0.02 suggested a significant association of Left atrial volume index with Mortality. Left atrial volume index gives positive association with mortality, for Left atrial volume index greater than 40, the odds ratio was 3.5.Mortality didn’t give any significant association with Ejection Fraction, Pulmonary artery systolic pressure and EE ratio. Conclusion : Increased Left atrial volume index is associated with higher mortality in End stage renal disease patients on maintenance hemodialysis. Increased Left atrial volume index was the best predictor of mortality among measured echocardiographic parameters in our hemodialysis population.