The prognostic value of left atrial strain in patients with end stage renal disease on dialysis

Abstract

Funding Acknowledgements Type of funding sources: None. Background Chronic kidney disease (CKD) is associated with higher incidence of cardiovascular death especially as the disease progresses and the patients undergo long term dialysis treatment (1). Left ventricular (LV) dysfunction evaluated by cardiac deformation measurements with speckle tracking echocardiography seems to have an important prognostic role in several different specific populations (2-4). Purpose Τhe prognostic value of strain analysis measurements, including the novel diastolic parameters such as left atrial (LA) strain, in patients with end-stage renal disease on dialysis (stage 5 CKD). Methods 67 patients (mean age 62.3 ± 11.8, 65.7% men) with stage 5 CKD (45 on hemodialysis and 22 on peritoneal dialysis) were enrolled in the study protocol. The mean duration of dialysis was 102.48 ± 84.98 months. Patients were submitted to a transthoracic echocardiogram at rest and dobutamine stress contrast echo (DSCE) protocol. Mean follow-up lasted five years. Results The majority of the study population had normal or mildly impaired systolic function with a mean LV ejection fraction 49.17% (±10.41) while 70% of the patients had impaired LV global longitudinal strain, (mean 14.35%, ±4.49). Regarding LA strain parameters the mean LA reservoir, LA conduit, and LA contractile reserve were 24.11%(±12.61), 10.56% (±5.88) and 13.60% (±9.15) respectively. Thus 50% of the population had impaired LA strain. DSCE was positive for ischemia in 55.7%. The 5-year cumulative event-free survival was 58.2% (±6.7), while 30% of major events happened during the first 2 years after DSCE (see Figure). Logistic regression analysis showed that of the various echocardiographic parameters LV ejection fraction, LV global longitudinal strain, and the conduit phase of LA strain were significantly associated with DSCE result and total prognosis (p = 0.009, p = 0.007, p = 0.05, and p = 0.005, p = 0.049, p = 0.043, respectively). The conduit element of LA strain notably was the strongest predictor among them(OR = 0.76 p = 0.05 and OR = 0.72 p = 0.043, respectively). Conclusion Left ventricular diastolic dysfunction is an important prognostic factor among patients with advanced CKD under long-term dialysis. The novel echocardiographic parameters such as LA strain couldadd valuable information to the overall cardiac evaluation of this specific population. Abstract Figure.