title: Left atrial volume and adverse cardiovascular outcomes in unselected patients with and without CKD.
abstract: OBJECTIVE
  Patients with CKD have increased cardiovascular morbidity and mortality. This study investigated the prognostic value of common clinical echocardiographic parameters.
  
  
  METHODS
  There were 289 unselected consecutive patients who had a transthoracic echocardiogram between January and June 2003. Patients with stage 3 or 4 CKD (n=49) were compared with those with eGFR≥60 ml/min per 1.73 m(2), n=240). Left ventricular volume, ejection fraction and mass, left atrial volume, and function parameters were measured. The primary endpoint, determined a priori, was a composite of cardiac death, myocardial infarction, and congestive cardiac failure.
  
  
  RESULTS
  Patients were followed for a median 5.6 years. The incidence of the primary endpoint was higher in patients with CKD (29% versus 12%, P=0.001), who were older and had a higher prevalence of hypertension and ischemic heart disease. Indexed left ventricular mass (LVMI) and left atrial volume (LAVI) were higher in patients with CKD. Furthermore, patients with LAVI>32 ml/m(2) had significantly lower event-free survival than patients with normal (<28 ml/m(2)) or mildly dilated LAVI (28-32 ml/m(2)) (P<0.001). Multivariate analysis showed that age (odds ratio [OR], 1.19; 95% confidence interval [95% CI], 1.08 to 1.31; P=0.001) and LVMI (OR, 3.66; 95% CI, 2.47 to 5.41; P<0.001) were independently associated with LAVI>32 ml/m(2). Multivariate Cox regression analysis demonstrated that CKD (hazard ratio [HR], 1.13; 95% CI, 1.01 to 1.26; P=0.04), hypertension (HR, 2.18; 95% CI, 1.05 to 4.54; P=0.04), and a larger LAVI (HR, 1.35; 95% CI, 1.02 to 1.77; P=0.04) were independent predictors of the primary endpoint.
  
  
  CONCLUSIONS
  Patients with CKD were at higher risk for cardiovascular events. LAVI was significantly larger in the CKD group and was a predictor of adverse cardiac events.
authors.affiliation: Cardiology Department, Liverpool Hospital, Sydney, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia;
authors.forename: Leia
authors.initials: L
authors.lastname: Hee
authors.affiliation: Cardiology Department, Liverpool Hospital, Sydney, New South Wales, Australia;
authors.forename: Tuan
authors.initials: T
authors.lastname: Nguyen
authors.affiliation: Cardiology Department, Liverpool Hospital, Sydney, New South Wales, Australia;
authors.forename: Melinda
authors.initials: M
authors.lastname: Whatmough
authors.affiliation: South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia; Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia; and.
authors.forename: Joseph
authors.initials: J
authors.lastname: Descallar
authors.affiliation: South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia;
authors.forename: Jack
authors.initials: J
authors.lastname: Chen
authors.affiliation: Cardiology Department, Liverpool Hospital, Sydney, New South Wales, Australia;
authors.forename: Shruti
authors.initials: S
authors.lastname: Kapila
authors.affiliation: Cardiology Department, Liverpool Hospital, Sydney, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia;
authors.forename: John K
authors.initials: JK
authors.lastname: French
authors.affiliation: Cardiology Department, Liverpool Hospital, Sydney, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia; Western Clinical School, University of Sydney, Sydney, New South Wales, Australia l.thomas@unsw.edu.au.
authors.forename: Liza
authors.initials: L
authors.lastname: Thomas
mesh_terms: D000328:Adult; D000368:Aged; D016279:Atrial Function, Left; D064752:Atrial Remodeling; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D018572:Disease-Free Survival; D015150:Echocardiography, Doppler; D005260:Female; D005919:Glomerular Filtration Rate; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009517:New South Wales; D016017:Odds Ratio; D015995:Prevalence; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016277:Ventricular Function, Left
keywords: CKD; cardiovascular disease; congestive heart failure; echocardiography; left ventricular hypertrophy