Left Atrial Function and Volume an Independent Markers of Cardiovascular Involvement in Early Chronic Kidney Disease

Aim: value of left atrium (LA) volume and function evaluated by strain analysis in the detection of myocardial involvement in early chronic kidney disease (CKD) patients with coexistent of hypertension.

Methods: 33 patients with CKD stage 2 or stage 3, with mild hypertension compared with 32 age matched hypertensive patients with normal kidney function and 30 healthy control subjects, all participants underwent trans thoracic echocardiography to assess left ventricular (LV) systolic and diastolic function, LV mass and LA volume index (LAVI) by 2D and pulsed wave Doppler imaging, and LA segmental strain measured by tissue Doppler imaging (TDI).

Results: Stage 3 CKD had the most reduced diastolic function compared with other groups. (LAVI) was higher significantly in both CKD group (36.2+8.4 ml/m2) and HT group (34.31+4.75 ml/m2) compared to control group (22.18+3 ml/m2) (p=0.001), LAVI was significantly higher in stage 3 compared with stage 2 CKD (p=0.001), Global systolic strain (GS)was significantly reduced in CKD group (17.48+4.3%) compared to both HT group (27.92+5.17%) and controls (31.75+6.8%) (p=0.001), GS was significantly lower in HT group compared with controls (p=0.014), systolic strain of four left atrial walls were different significantly between CKD group and both HT and control groups. there was high significant difference between stage 2 and stage 3 CKD as regard left atrial lateral and anterior walls systolic strain (p=0.001), inferior and septal wall systolic strain were significantly lower in stage 3 compared to stage 2 CKD.

Conclusion: LA dysfunction and enlargement are evident in patients with early CKD, LA systolic strain was reduced in CKD earlier than LA enlargement which occur later, hence LA systolic strain and volume index could be used to detect myocardial involvement in early CKD.