Value of two-dimensional speckle-tracking echocardiography in the assessment of left atrial function in patients with chronic kidney disease.

Background: The rising prevalence of chronic kidney disease (CKD) has emerged as a global public health concern, posing a significant threat to human health. This study aimed to assess changes in left atrial (LA) function in patients with CKD with left ventricular hypertrophy (LVH) using two-dimensional speckle-tracking echocardiography (2D-STE) and to investigate the independent correlations between baseline parameters and LA strain and strain rate.

Methods: We conducted a prospective study that included patients diagnosed with CKD at Shenzhen People's Hospital between November 2020 and September 2021. Healthy participants were enrolled as a healthy control group. Conventional transthoracic echocardiography was performed to obtain conventional ultrasound parameters, with cines analyzed offline to determine strain and strain rate parameters. Single-factor analysis of variance was used to compare the groups. The relationship between different variables and LA strain and strain rate was analyzed by general linear regression. The relationship between left ventricular mass index (LVMI) and LA strain and strain rate was analyzed by multifactor linear regression.

Results: The study included 236 participants: 166 patients with CKD (85 in the CKD_{non-LVH (N-LVH)} group and 81 in the CKD_LVH group) and 70 healthy controls (CON group). The results showed that LA volume in the CKD_N-LVH group was not significantly different compared with that in the CON group (P>0.05), but the remaining LA strain and strain rate parameters were decreased (P<0.05), except for the LA global longitudinal strain during early diastole (LA Se) and LA global longitudinal strain rate during late diastole (LA SRa) (P>0.05). In the CKD_LVH group, LA strain and strain rate were further reduced as compared to those in the CKD_N-LVH group (P<0.05). Additionally, LA strain and strain rate were negatively correlated with age [vs. LA global longitudinal strain during systole (LA Ss): R=-0.36, P<0.001; vs. LA global longitudinal strain rate during systole (LA SRs): R=-0.24, P<0.001], systolic blood pressure (vs. LA Ss: R=-0.38, P<0.001; vs. LA SRs: R=-0.43, P<0.001), A peak (vs. LA Ss: R=-0.36, P<0.001; vs. LA SRs: R=-0.34, P<0.001), E/e' (vs. LA Ss: R=-0.44, P<0.001; vs. LA SRs: R=-0.54, P<0.001), LA volume index (LAVI) (vs. LA Ss: R=-0.35, P<0.001; vs. LA SRs: R=-0.52, P<0.001), and LVMI (vs. LA Ss: R=-0.46, P<0.001; vs. LA SRs: R=-0.55, P<0.001); meanwhile, LA strain and strain rate were positively correlated with glomerular filtration rate (GFR) (vs. LA Ss: R=0.50, P<0.001; vs. LA SRs: R=0.50, P<0.001) and e' (vs. LA Ss: R=0.58, P<0.001; vs. LA SRs: R=0.54, P<0.001). LVMI had an independent negative effect on all LA strain and strain rates (vs. LA Ss: β=-0.29, P<0.001; vs. LA SRs: β=-0.42, P<0.001).

Conclusions: LA strain and strain rate are valuable indicators for detecting early LA functional changes in patients with CKD. LVMI independently negatively impacts all LA strain and strain rates and may be a predictor of cardiovascular events.