Left atrial strain associated with alterations in cardiac diastolic function in patients with end-stage renal disease

Abstract

The purpose of this study was to investigate the correlation between left atrial (LA) strain and alterations in cardiac diastolic function in patients with end-stage renal disease. 59 patients with stage 5 chronic kidney disease(CKD5) and 30 healthy controls were enrolled in this study. Patients with CKD5 were divided into three groups, from normal to Grade II diastolic dysfunction. LA longitudinal strain was evaluated using two-dimensional speckle tracking echocardiography. The peak LA longitudinal strain values (PALS) and LA stiffness index were recorded as the main parameters. Comparing with control group, index of LA volume (LAVI, 14.57 ± 6.92 vs. 20.15 ± 6.21 vs. 30.49 ± 10.66 vs. 42.99 ± 18.77) and index of left ventricular mass (LVMI, 77.64 ± 12.60 vs. 103.83 ± 15.90 vs. 155.01 ± 36.92 vs. 178.34 ± 44.47) significantly increased in CKD5 patients, along with the decline of diastolic function (p < 0.001). An incremental reduction in PALS (51.75 ± 5.82 vs. 40.23 ± 12.72 vs. 36.37 ± 8.59 vs. 33.33 ± 9.30, p < 0.001) as well as increase in LA stiffness index (0.11 ± 0.02 vs. 0.25 ± 0.10 vs. 0.38 ± 0.21 vs. 0.61 ± 0.51, p = 0.003) in apical 4 chamber (A4C) view and global value were observed in CKD5 patients, and higher LA stiffness index were shown in patients with Grade II diastolic dysfunction. What's more, estimated glomerular filtration rate was independently correlated with PALS-A4C (B = 0.084, 95% CI 0.002-0.166, p = 0.046), and LAVI adversely correlated with PALS-A4C (B=-0.191, 95% CI -0.379 to -0.002), p = 0.047) and correlated with LA stiffness index in A4C (B = 0.011, 95% CI 0.006 -0.017, p < 0.001). In conclusion, LA longitudinal strain, combined with LAVI and LVMI, were independently associated with the decline in diastolic function in CKD5 patients, which might provide novel cardiovascular events predictors in these patients.