Left Atrial 2D Speckle Tracking Echocardiography as a Prognostic Marker in Patients With Chronic Kidney Disease

Abstract

Background: Patients with chronic kidney disease (CKD) are at increased risk of cardiovascular events that is underestimated by traditional risk stratification algorithms. We evaluated clinical and echocardiographic parameters that would determine long-term adverse outcomes in CKD patients. Methods: Patients with Stage 3/4 CKD without previous cardiac disease were prospectively recruited. Participants underwent a comprehensive transthoracic echocardiogram with detailed assessment of left ventricular (LV) and left atrial (LA) size and function including strain analysis; a stress echocardiogram was additionally performed to rule out latent ischaemia. Participants were followed annually for 5 years for adverse events, corroborated with hospital records and registry data. The primary end point was a composite of all-cause death and major adverse cardiovascular events (MACE). Results: A total of 243 patients (male 63%; mean age 59.23 ± 14.44 years) were followed for a median of 46.90 ± 32.56 months. 69 patients met the composite endpoints of death and MACE; these patients were older with history of DM. On Kaplan Meier analysis, age (p < 0.01), DM (p < 0.01), LV mass (p < 0.01), LV GLS (p < 0.01), LAVI (p < 0.01) and LA GLS (p < 0.01) were independent predictors for death and MACE. On multiple Cox proportional hazards analysis, LA GLS (p < 0.01) was the only significant predictor for death and MACE in a model accounting for the effect of age, DM, LV mass, LV GLS, E/e’ and LAVI. Conclusions: LA GLS is an independent predictor of death and adverse cardiovascular events in patients with CKD. LA GLS is a potential prognostic biomarker, possibly reflecting alterations in diastolic function with CKD.