Journal
JOURNAL OF THE AMERICAN HEART ASSOCIATION
Volume 10, Issue 1, Pages -Publisher
WILEY
DOI: 10.1161/JAHA.120.017840
Keywords
chronic kidney disease; diastolic dysfunction; exercise capacity; exercise echocardiography; left atrial strain; left atrium
Categories
Funding
- National Health and Medical Research Council Scholarship [GNT1018215]
- University of New South Wales Postgraduate Award [UNSW3080080]
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This study investigated the relationship between left atrial function and exercise capacity in patients with chronic kidney disease, finding that LASr is the parameter most strongly correlated with exercise capacity and has similar diagnostic value to exercise E/e'. LASr could serve as a resting biomarker of functional capacity in this population.
Background Left atrial (LA) function plays a pivotal role in modulating left ventricular performance. The aim of our study was to evaluate the relationship between resting LA function by strain analysis and exercise capacity in patients with chronic kidney disease (CKD) and evaluate its utility compared with exercise E/e'. Methods and Results Consecutive patients with stage 3 and 4 CKD without prior cardiac history were prospectively recruited from outpatient nephrology clinics and underwent clinical evaluation and resting and exercise stress echocardiography. Resting echocardiographic parameters including E/e' and phasic LA strain (LA reservoir [LASr], conduit, and contractile strain) were measured and compared with exercise E/e'. A total of 218 (63.9 +/- 11.7 years, 64% men) patients with CKD were recruited. Independent clinical parameters associated with exercise capacity were age, estimated glomerular filtration rate, body mass index, and sex (P<0.01 for all), while independent resting echocardiographic parameters included E/e', LASr, and LA contractile strain (P<0.01 for all). Among resting echocardiographic parameters, LASr demonstrated the strongest positive correlation to metabolic equivalents achieved (r=0.70; P<0.01). Receiver operating characteristic curves demonstrated that LASr (area under the curve, 0.83) had similar diagnostic performance as exercise E/e' (area under the curve, 0.79; P=0.20 on DeLong test). A model combining LASr and clinical metrics showed robust association with metabolic equivalents achieved in patients with CKD. Conclusions LASr, a marker of decreased LA compliance is an independent correlate of exercise capacity in patients with stage 3 and 4 CKD, with similar diagnostic value to exercise E/e'. Thus, LASr may serve as a resting biomarker of functional capacity in this population.
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