Evaluation of left atrial function using two-dimensional speckle tracking echocardiography in end-stage renal disease patients with preserved left ventricular ejection fraction

Abstract

Left atrial (LA) deformation analysis by two-dimensional speckle tracking echocardiography (2D-STE) has recently been proposed as an alternative approach for estimating left ventricular (LV) filling pressure and dysfunction. To assess the LA myocardial function using 2D-STE in end-stage renal disease (ESRD) patients with preserved LV ejection fraction (PLVEF) and to evaluate the relationship of the obtained results with echocardiographically estimated pulmonary capillary wedge pressure (ePCWP). Eighty-five ESRD patients and 60 healthy individuals were enrolled in the study. Images of the LA were acquired from apical two- and four-chamber views. The LA volumes (LAV) were calculated using the biplane area-length method. The LA volume indices (LAVI) were calculated by dividing the LA volumes by the body surface area. The LA strain (%) (LAS) parameters (systolic [LA(S-S)], early diastolic [LA(S-E)], late diastolic [LA(S-A)] during atrial contraction) were assessed, and the ePCWP was calculated according to the following formula: ePCWP = 1.25(E/E') + 1.9. LA stiffness was calculated non-invasively and based on the ratio of E/E' to LAS-S. In patients with ESRD, the LA(S-S) (32.22 ± 7.64% vs. 57.93 ± 8.71%; p < 0.001), LA(S-E) (-15.86 ± 5.7% vs. -33.37 ± 7.71%; p < 0.001), and the LA(S-A) (-15.41 ± 4.16% vs. -24.57 ± 4.68%; p < 0.001) values were observed to be lower than the healthy group; while the LA stiffness (0.4 ± 0.19 vs. 0.17 ± 0.05; p < 0.001) value was higher. When the patients with ESRD were divided into two groups as those with a maximum LAVI value over 31.34 mL/m² and those with a maximum LAVI below this value, the LA(S-S) (30.36 ± 8.32% vs. 34.11 ± 6.43%; p = 0.023) and the LA(S-E) (-14.97 ± 5.88% vs. -16.76 ± 5.42%; p = 0.039) values were lower in the group with a LAVI value over 31.34 mL/m²; while the LA(S-A) (-16.06 ± 4.44% vs. -14.75 ± 3.8%; p < 0.001) and LA stiffness (0.4 ± 0.19 vs. 0.17 ± 0.05; p < 0.001) values were higher. An association was observed between the ePCWP and LA(S-S) (p < 0.001), LAS-E (p = 0.01), LA(S-A) (p < 0.001), and LA stiffness (p < 0.001) values. The results of our study have demonstrated that LA myocardial function assessed using the 2D-STE method is associated with the ePCWP, which is an echocardiographically calculated marker of LV dysfunction. The LA deformation parameters may be used as echocardiographic findings to predict the LV dysfunction in ESRD patients with PLVEF. Further studies are needed to determine the independent prognostic power of the atrial strain measurement as a predictor of future cardiovascular events in ESRD patients.