Left atrial volume and adverse cardiovascular outcomes in unselected patients with and without CKD

Leia Hee; Tuan Nguyen; Melinda Whatmough; Joseph Descallar; Jack Chen; Shruti Kapila; John K French; Liza Thomas

doi:10.2215/CJN.06700613

Left atrial volume and adverse cardiovascular outcomes in unselected patients with and without CKD

Clin J Am Soc Nephrol. 2014 Aug 7;9(8):1369-76. doi: 10.2215/CJN.06700613. Epub 2014 Jun 12.

Authors

Leia Hee¹, Tuan Nguyen², Melinda Whatmough², Joseph Descallar³, Jack Chen⁴, Shruti Kapila², John K French¹, Liza Thomas⁵

Affiliations

¹ Cardiology Department, Liverpool Hospital, Sydney, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia;
² Cardiology Department, Liverpool Hospital, Sydney, New South Wales, Australia;
³ South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia; Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia; and.
⁴ South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia;
⁵ Cardiology Department, Liverpool Hospital, Sydney, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia; Western Clinical School, University of Sydney, Sydney, New South Wales, Australia l.thomas@unsw.edu.au.

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.

Keywords: CKD; cardiovascular disease; congestive heart failure; echocardiography; left ventricular hypertrophy.

Publication types

Observational Study

MeSH terms

Adult
Aged
Atrial Function, Left*
Atrial Remodeling*
Cardiovascular Diseases / diagnostic imaging
Cardiovascular Diseases / etiology*
Cardiovascular Diseases / mortality
Cardiovascular Diseases / physiopathology
Disease-Free Survival
Echocardiography, Doppler
Female
Glomerular Filtration Rate
Heart Atria / diagnostic imaging
Heart Atria / physiopathology
Humans
Incidence
Kaplan-Meier Estimate
Kidney / physiopathology
Male
Middle Aged
Multivariate Analysis
New South Wales
Odds Ratio
Prevalence
Proportional Hazards Models
Renal Insufficiency, Chronic / complications*
Renal Insufficiency, Chronic / diagnosis
Renal Insufficiency, Chronic / mortality
Renal Insufficiency, Chronic / physiopathology
Retrospective Studies
Risk Assessment
Risk Factors
Stroke Volume
Time Factors
Ventricular Function, Left