Valor prognóstico do índice do volume do átrio esquerdo em pacientes em hemodiálise

Abstract

SummaryObjective: To evaluate the prognostic value of left atrial volume index (LAVi) in the clinical course of hemodialysis (HD) patients, compared with previously established echocardiographic and clinical parameters.Methods: Echocardiograms were obtained from 118 hemodialysis patients, who were then followed for 19 ± 8 months. Study endpoint was a composite of all-cause mortality and nonfatal cardiovascular events. Cox multivariate analysis was used do assess the independent prognostic value of LAVi.Results: On univariate analysis, LAVi and other clinical and echocardiographic parameters were predictive of prognosis. Multivariate analyses showed that LAVi was an independent predictor of prognosis (hazard ratio 1.03 per ml/m 2 , 95% confidence interval: 1.01 to 1.05, p=0.014), and added incremental information to the model containing traditional predictors of cardiovascular risk, such as left ventricular mass, ejection fraction, and clinical variables (p=0.02).Conclusion: LAVi is an independent predictor of prognosis in HD patients, providing incremental information to traditional clinical and Doppler echocardiographic data. (Arq Bras Cardiol 2007;88(6):568-575)

Parâmetros ecocardiográficos como preditores de eventos cardiovasculares em pacientes em hemodiálise

“…In a study of a population on renal replacement therapy, Barberato et al 33 showed that LAVI was a predictor of mortality. In this study, although LAVI was mildly elevated in both groups, the variable was not an independent predictor of cardiovascular events and cardiovascular mortality.…”

Estudo das alterações ecocardiográficas nos primeiros seis meses após o transplante renal

“…The estimation of left atrial volume by echocardiography is an independent predictor of death and cardiovascular events in patients with CKD undergoing dialysis 28,32 . There have been no previous data evaluating the evolution of left atrial volume after kidney transplantation.…”

Echocardiography in Chronic Kidney Disease: Diagnostic and Prognostic Implications

“…In studies using different methodologies, the prevalence of systolic dysfunction of LV varies from 15 to 28% in patients on dialysis [7,9,16]. LV systolic dysfunction is a powerful indicator of unfavorable prognosis in patients on HD [11] as well as those in the post-renal transplant phase [7].…”

“…A study of HD patients in sinus rhythm without mitral valvopathy demonstrated that LA volume indexed for body surface of >35 ml/m 2 was the most accurate parameter for detection of pseudonormalization of mitral flow in comparison to several previously tested indices [25]. Broadening the clinical value of LA volume, 2 recent publications reported, utilizing different indexation methods (body surface [16] or height 2.7 [26]), that this index was an independent predictor of mortality in patients on renal replacement therapy. The finding that an indexed LA volume of >32 ml/m 2 supplied information complementary to the clinical and traditional echocardiographic data, including ejection fraction, E/E’ ratio and LV ventricular mass [16].…”

“…Broadening the clinical value of LA volume, 2 recent publications reported, utilizing different indexation methods (body surface [16] or height 2.7 [26]), that this index was an independent predictor of mortality in patients on renal replacement therapy. The finding that an indexed LA volume of >32 ml/m 2 supplied information complementary to the clinical and traditional echocardiographic data, including ejection fraction, E/E’ ratio and LV ventricular mass [16]. In parallel, a study of patients with advanced CKD found an independent association between LA volume and C-reactive protein, suggesting that inflammation may contribute to LA dilatation relation to increased risk [27].…”