OBJECTIVE: An enlarged left atrium (LA) has recently been identified as a risk factor for adverse cardiovascular outcomes in various pathologic conditions. However, few studies have evaluated its prognostic value in hemodialysis (HD) patients. METHODS: We conducted an observational study to investigate whether an enlarged LA predicted all-cause mortality in 174 HD patients. Patients were stratified into two groups based on the LA volume index (LAVI) value of 32 mL/m<sup>2</sup>. RESULTS: An increased left atrial volume index (LAVI >32 mL/m(2)) was present in 28 (16.1%) of the HD patients. During the follow-up period (50.1 ± 22.4 months), 77 patients (44.3%) died. A Kaplan-Meier analysis revealed that the 7-year survival rate was significantly lower in the group whose LAVI was >32 mL/m(2) than in the group whose LAVI was ≤ 32 mL/m(2) (p=0.0033). Multivariate analyses adjusted for echocardiographic parameters and clinical and laboratory data showed that increased LAVI was an independent predictor of all-cause mortality (hazard ratio 1.030, 95% confidence interval 1.004-1.056, p=0.0260). Moreover, increased LAVI had a higher predictive value for all-cause mortality (area under the receiver operating characteristic curve=0.612, p=0.0059) among the measured echocardiographic parameters. CONCLUSION: The results of the present study suggested that measurement of LAVI may be helpful in the risk stratification of HD patients and in providing therapeutic direction for their management.
OBJECTIVE: An enlarged left atrium (LA) has recently been identified as a risk factor for adverse cardiovascular outcomes in various pathologic conditions. However, few studies have evaluated its prognostic value in hemodialysis (HD) patients. METHODS: We conducted an observational study to investigate whether an enlarged LA predicted all-cause mortality in 174 HDpatients. Patients were stratified into two groups based on the LA volume index (LAVI) value of 32 mL/m<sup>2</sup>. RESULTS: An increased left atrial volume index (LAVI >32 mL/m(2)) was present in 28 (16.1%) of the HDpatients. During the follow-up period (50.1 ± 22.4 months), 77 patients (44.3%) died. A Kaplan-Meier analysis revealed that the 7-year survival rate was significantly lower in the group whose LAVI was >32 mL/m(2) than in the group whose LAVI was ≤ 32 mL/m(2) (p=0.0033). Multivariate analyses adjusted for echocardiographic parameters and clinical and laboratory data showed that increased LAVI was an independent predictor of all-cause mortality (hazard ratio 1.030, 95% confidence interval 1.004-1.056, p=0.0260). Moreover, increased LAVI had a higher predictive value for all-cause mortality (area under the receiver operating characteristic curve=0.612, p=0.0059) among the measured echocardiographic parameters. CONCLUSION: The results of the present study suggested that measurement of LAVI may be helpful in the risk stratification of HDpatients and in providing therapeutic direction for their management.
Authors: Kathrin Untersteller; Nicolas Girerd; Kevin Duarte; Kyrill S Rogacev; Sarah Seiler-Mussler; Danilo Fliser; Patrick Rossignol; Gunnar H Heine Journal: Clin J Am Soc Nephrol Date: 2016-08-11 Impact factor: 8.237