title: Association of chronic kidney disease with impaired left atrial reservoir function: A community-based cohort study.
abstract: Background Chronic kidney disease (CKD) is an independent risk factor for atrial fibrillation, although the pathophysiological mechanisms remain unclear. This study investigated the relationship between CKD and left atrial (LA) volume and function in a sample of the general population without overt cardiac disease. Design and methods We examined 358 participants from the Cardiovascular Abnormalities and Brain Lesions study. The LA minimum volume index (LAVImin), LA maximum volume index (LAVImax), and LA emptying fraction (LAEF) were assessed by real-time three-dimensional echocardiography. Based on their estimated glomerular filtration rate (eGFR), the participants were divided into a CKD group (eGFR <60 ml/min/1.73 m2) and a non-CKD group (eGFR ≥60 ml/min/1.73 m2). Results Of the 358 participants, 69 (19%) were classified as having CKD and 289 (81%) as non-CKD. Participants with CKD were older, had a greater prevalence of hypertension and use of antihypertensive drugs, a larger left ventricular (LV) mass index, and a higher prevalence of diastolic dysfunction than those without CKD (all p < 0.05). There was no significant difference in LAVImaxbetween the CKD and non-CKD groups (23.4 ± 7.1 vs. 22.8 ± 5.8 ml/m2, p = 0.47), whereas significant differences were observed for LAVImin(13.6 ± 5.5 vs. 12.0 ± 4.6 ml/m2, p = 0.01) and LAEF (42.7 ± 11.4 vs. 47.8 ± 11.5%, p = 0.001). Multivariate regression analysis revealed that the eGFR was significantly associated with LAEF independent of age, LV mass index, and diastolic dysfunction (all p < 0.05). Conclusions Participants with CKD in an unselected community-based cohort had significantly impaired LA reservoir function. Assessment of LA function may add important information in the prognostic assessment of patients with CKD even in the absence of overt cardiac disease.
authors.affiliation: 1 Department of Medicine, Columbia University, USA.
authors.forename: Koki
authors.initials: K
authors.lastname: Nakanishi
authors.affiliation: 2 Department of Biostatistics, Columbia University, USA.
authors.forename: Zhezhen
authors.initials: Z
authors.lastname: Jin
authors.affiliation: 1 Department of Medicine, Columbia University, USA.
authors.forename: Cesare
authors.initials: C
authors.lastname: Russo
authors.affiliation: 1 Department of Medicine, Columbia University, USA.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Homma
authors.affiliation: 3 Department of Neurology, Columbia University, USA.|4 Department of Epidemiology, Columbia University, USA.
authors.forename: Mitchell Sv
authors.initials: MS
authors.lastname: Elkind
authors.affiliation: 5 Department of Neurology, Miller School of Medicine, University of Miami, USA.|6 Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami, USA.
authors.forename: Tatjana
authors.initials: T
authors.lastname: Rundek
authors.affiliation: 1 Department of Medicine, Columbia University, USA.
authors.forename: Aylin
authors.initials: A
authors.lastname: Tugcu
authors.affiliation: 5 Department of Neurology, Miller School of Medicine, University of Miami, USA.|6 Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami, USA.|7 Department of Human Genetics, Miller School of Medicine, University of Miami, USA.
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
authors.affiliation: 1 Department of Medicine, Columbia University, USA.
authors.forename: Marco R
authors.initials: MR
authors.lastname: Di Tullio
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016279:Atrial Function, Left / Q000502:physiology*; D015331:Cohort Studies; D019560:Echocardiography, Three-Dimensional; D005260:Female; D005919:Glomerular Filtration Rate; D006325:Heart Atria / Q000000981:diagnostic imaging; D006331:Heart Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology*; D012307:Risk Factors
keywords: Chronic kidney disease; left atrial function; real-time three-dimensional echocardiography