BACKGROUND: End-stage renal disease (ESRD) is a high-risk condition and left ventricular hypertrophy (LVH) is the strongest risk factor in this population. OBJECTIVE AND METHODS: Since the prognostic value of left atrial (LA) size in ESRD is still unknown, we performed a prospective cohort study aimed at testing the prognostic value of LA volume in a cohort of 249 ESRD patients. RESULTS: Both un-indexed and indexed LA volume (LAV) was significantly higher in dialysis patients than in healthy subjects (P < 0.001). On multivariate analysis only left ventricular mass index (LVMI), LV ejection fraction (LVEF), ratio of early (E) to late atrial (A) mitral Doppler peak flow velocity (E/A ratio) and antihypertensive treatment maintained an independent association with LAV. During the follow-up 113 patients died. LAV added significant prognostic power to a multivariate Cox model of all-cause death and the model based on height provided the best data fit. Notably, this index maintained an independent predictive value for death (P = 0.03) also when LVMI and LVEF were jointly forced into the Cox's model. Neither crude nor body surface area (BSA)-adjusted LAV had an independent association with death when tested in the Cox model including LVMI and LVEF. CONCLUSIONS: In patients with ESRD, LAV indexed for height displays prognostic value beyond and above that provided by LV mass and function.
BACKGROUND: End-stage renal disease (ESRD) is a high-risk condition and left ventricular hypertrophy (LVH) is the strongest risk factor in this population. OBJECTIVE AND METHODS: Since the prognostic value of left atrial (LA) size in ESRD is still unknown, we performed a prospective cohort study aimed at testing the prognostic value of LA volume in a cohort of 249 ESRDpatients. RESULTS: Both un-indexed and indexed LA volume (LAV) was significantly higher in dialysis patients than in healthy subjects (P < 0.001). On multivariate analysis only left ventricular mass index (LVMI), LV ejection fraction (LVEF), ratio of early (E) to late atrial (A) mitral Doppler peak flow velocity (E/A ratio) and antihypertensive treatment maintained an independent association with LAV. During the follow-up 113 patients died. LAV added significant prognostic power to a multivariate Cox model of all-cause death and the model based on height provided the best data fit. Notably, this index maintained an independent predictive value for death (P = 0.03) also when LVMI and LVEF were jointly forced into the Cox's model. Neither crude nor body surface area (BSA)-adjusted LAV had an independent association with death when tested in the Cox model including LVMI and LVEF. CONCLUSIONS: In patients with ESRD, LAV indexed for height displays prognostic value beyond and above that provided by LV mass and function.
Authors: Tamryn K Law; Ron Wald; Marc Goldstein; Gauri R Karur; Ming-Yen Ng; Angela Y M Wang; Djeven P Deva; Anish Kirpalani; Rachel M Wald; Mercedeh Kiaii; Jonathon Leipsic; Kim A Connelly; Andrew T Yan Journal: J Nephrol Date: 2018-08-24 Impact factor: 3.902
Authors: Leia Hee; Tuan Nguyen; Melinda Whatmough; Joseph Descallar; Jack Chen; Shruti Kapila; John K French; Liza Thomas Journal: Clin J Am Soc Nephrol Date: 2014-06-12 Impact factor: 8.237
Authors: Flora Huang; Philip W Connelly; G V Ramesh Prasad; Michelle M Nash; Lakshman Gunaratnam; Djeven P Deva; Charmaine E Lok; Weiqiu Yuan; Rachel M Wald; Tamar Shalmon; Ron Wald; Kim A Connelly; Andrew T Yan Journal: J Nephrol Date: 2020-09-10 Impact factor: 3.902