Left Atrial Strain Value Versus Tissue Doppler Echocardiography and the Left Atrium Volume Index in the Evaluation of Left Ventricular Diastolic Function in Patients with Chronic Kidney Disease.

Abstract

Background: In heart failure with preserved ejection fraction (HFpEF) and decreased ejection fraction (HFrEF), LA strain, an indicator of the filling and discharge of the left atrium (LA), was recently identified as a sign of diastolic dysfunction. Our objective was to examine the significance of left atrial (LA) strain relative to tissue Doppler echocardiography and the left atrial volume index (LAVI) in evaluating left ventricular (LV) diastolic performance in individuals with chronic kidney disease (CKD). Methods: A prospective cross-sectional study was conducted on 220 outpatients with CKD who fulfilled the inclusion criteria and were referred to the cardiology clinic at Tanta University for routine echocardiographic assessment during a period of 6 months (April to September 2024). Based on their estimated glomerular filtration rate (eGFR), patients were divided into five groups: GFR ranges from 90 to 120 mL/min/1.73 m² in Group 1, 60 to 90 mL/min/1.73 m² in Group 2, 30 to 60 mL/min/1.73 m² in Group 3, 15 to 29 mL/min/1.73 m² in Group 4, and less than 15 mL/min/1.73 m² in Group 5. All participants were evaluated using echocardiographic measurements, such as the E/e ratio, left ventricular systolic and diastolic volumes, left atrial strain, left atrial volume index (LAVI), and ejection fraction (EF). Results: LA strain conduit and reservoir strain can significantly diagnose LV diastolic function in CKD patients (p < 0.001; AUC = 0.819 and 0.869, respectively) using cutoffs of ≤36 and ≥23, with 86% and 95.5% sensitivity, 65% and 60% specificity, 96.1% and 96% PPV, and 31.7% and 57.1%, NPV respectively. An AUC = 0.926 was observed with LAVI among grade 1 vs. grade 0 (0.9 is considered excellent in diagnosing patients with and without the disease). Other markers had AUC values of 0.5-0.6 among the grades of the diastolic function, suggesting no discrimination in diagnosing the disease. Conclusions: LA conduit strain and reservoir strain are independent markers that represent a superior and more sensitive approach than LAVI and tissue Doppler echocardiography for evaluating LV diastolic dysfunction in patients with CKD, even in the early stages.