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European Journal of Echocardiography Advance Access originally published online on March 20, 2008
European Journal of Echocardiography 2008 9(6):736-740; doi:10.1093/ejechocard/jen131
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Prognostic value of left atrial size in chronic kidney disease

Mark Y. Chan1,*, Hwee-Bee Wong2, Hean-Yee Ong3 and Tiong-Cheng Yeo1

1 The Heart Institute, National University Hospital, Singapore
2 Clinical Trials and Epidemiology Research Unit, Singapore
3 The Heart Institute, Alexander Hospital, Singapore

Received 23 November 2007; accepted after revision 2 March 2008; online publish-ahead-of-print 20 March 2008.

* Corresponding author: Duke Clinical Research Institute, 2400 Pratt Street, Terrace Level Rm 0311, Durham, NC 27705, USA. Tel: +1 919 668 8730; fax: +1 919 668 7057 E-mail address: mark.chan{at}duke.edu


  Abstract

Aims: Patients with chronic kidney disease (CKD) have high cardiovascular risk. Although stress imaging provides accurate risk estimation in this population, it is unknown if combinatorial cardiac imaging adds incremental value.

Methods and results: We performed transthoracic echocardiography and stress single photon emission computed tomography (SPECT) to assess their value in predicting late cardiovascular disease (CVD) mortality in 200 patients with creatinine clearance <60 mL/min without a history of coronary heart disease. During a median follow-up duration of 3.7 (3.5–4.0) years, there were 25 deaths because of CVD. Older age, abnormal SPECT, and increased indexed left atrial (LA) diameter were associated with CVD mortality on univariate analysis with P = 0.007, 0.01, and 0.004, respectively. In multivariable analysis, indexed LA diameter >24 mm/m2 was independently predictive of CVD mortality [hazard ratio (HR) 2.75, confidence interval (CI) 1.14–6.59], but abnormal SPECT was not. Each mm/m2 increase in indexed atrial diameter was associated with an HR 1.20 (95% CI 1.06–1.37).

Conclusions: In patients with CKD, the indexed LA diameter predicts CVD mortality independent of an abnormal SPECT result. Consideration should be given to this simple measurement as a prognostic tool in this population.

Keywords: Kidney failure; Chronic; Heart atria; Echocardiography; Tomography; Emission-computed


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