Left atrial mechanics in youth with chronic kidney disease and similarly aged healthy controls.

Background: In adults with chronic kidney disease (CKD), abnormal left atrial reservoir strain (LASr) is an early, yet clinically significant, indicator of myocardial dysfunction. However, left atrial mechanics are understudied in youth with CKD. The objective of this study was to assess left atrial strain function in youth with CKD and similarly aged, healthy controls.

Methods: We performed a single-center, retrospective, observational study of persons aged 12-21 years with stage 3-4 CKD and healthy controls. Exclusion criteria included a history of a kidney or other solid organ transplant, congenital heart disease, and/or dialysis requirement < 3 months prior. We measured LAS (LASr, conduit, and contractile), E/e', E/A, left ventricular mass index (LVMI), and ejection fraction. Pearson correlations were performed between echocardiographic measures.

Results: This study included 37 patients with CKD and 19 controls. Mean age was similar between groups, and male sex was over-represented in both groups (CKD 62%; healthy 63%). Mean ± standard deviation (SD) eGFR in the CKD group was 32 ± 14 mL/min/1.73 m². Mean absolute LASr was lower in those with CKD (43.0 ± 8.5%) compared to healthy controls (47.4 ± 6.1%) p = 0.050. Patients with CKD had significantly higher LVMI and lower E/A and E' compared to controls. There was poor correlation between LASr with E/A, E/e', and LVMI.

Conclusions: As observed in adults with CKD, LASr trended lower in youth with CKD compared to healthy controls. Moreover, LASr poorly correlated with traditional measures of diastolic dysfunction such as E/e' and E/A.