Vol 71, No 4 (2013)
Original articles
Published online: 2013-04-18
Evaluation of left atrial function using two-dimensional speckle tracking echocardiography in end-stage renal disease patients with preserved left ventricular ejection fraction
DOI: 10.5603/KP.2013.0061
Kardiol Pol 2013;71(4):341-351.
Abstract
Background: Left atrial (LA) deformation analysis by two-dimensional speckle tracking echocardiography (2D-STE) has recently
been proposed as an alternative approach for estimating left ventricular (LV) filling pressure and dysfunction.
Aim: To assess the LA myocardial function using 2D-STE in end-stage renal disease (ESRD) patients with preserved LV ejection
fraction (PLVEF) and to evaluate the relationship of the obtained results with echocardiographically estimated pulmonary
capillary wedge pressure (ePCWP).
Methods: Eighty-five ESRD patients and 60 healthy individuals were enrolled in the study. Images of the LA were acquired
from apical two- and four-chamber views. The LA volumes (LAV) were calculated using the biplane area-length method.
The LA volume indices (LAVI) were calculated by dividing the LA volumes by the body surface area. The LA strain (%) (LAS)
parameters (systolic [LAS-S], early diastolic [LAS-E], late diastolic [LAS-A] during atrial contraction) were assessed, and the ePCWP
was calculated according to the following formula: ePCWP = 1.25(E/E’) + 1.9. LA stiffness was calculated non-invasively and
based on the ratio of E/E’ to LAS-S.
Results: In patients with ESRD, the LAS-S (32.22 ± 7.64% vs. 57.93 ± 8.71%; p < 0.001), LAS-E (–15.86 ± 5.7% vs. –33.37 ± 7.71%;
p < 0.001), and the LAS-A (–15.41 ± 4.16% vs. –24.57 ± 4.68%; p < 0.001) values were observed to be lower than the healthy
group; while the LA stiffness (0.4 ± 0.19 vs. 0.17 ± 0.05; p < 0.001) value was higher. When the patients with ESRD were
divided into two groups as those with a maximum LAVI value over 31.34 mL/m2 and those with a maximum LAVI below this
value, the LAS-S (30.36 ± 8.32% vs. 34.11 ± 6.43%; p = 0.023) and the LAS-E (–14.97 ± 5.88% vs. –16.76 ± 5.42%; p = 0.039)
values were lower in the group with a LAVI value over 31.34 mL/m2; while the LAS-A (–16.06 ± 4.44% vs. –14.75 ± 3.8%;
p < 0.001) and LA stiffness (0.4 ± 0.19 vs. 0.17 ± 0.05; p < 0.001) values were higher. An association was observed between
the ePCWP and LAS-S (p < 0.001), LAS-E (p = 0.01), LAS-A (p < 0.001), and LA stiffness (p < 0.001) values.
Conclusions: The results of our study have demonstrated that LA myocardial function assessed using the 2D-STE method
is associated with the ePCWP, which is an echocardiographically calculated marker of LV dysfunction. The LA deformation
parameters may be used as echocardiographic findings to predict the LV dysfunction in ESRD patients with PLVEF. Further
studies are needed to determine the independent prognostic power of the atrial strain measurement as a predictor of future
cardiovascular events in ESRD patients.
been proposed as an alternative approach for estimating left ventricular (LV) filling pressure and dysfunction.
Aim: To assess the LA myocardial function using 2D-STE in end-stage renal disease (ESRD) patients with preserved LV ejection
fraction (PLVEF) and to evaluate the relationship of the obtained results with echocardiographically estimated pulmonary
capillary wedge pressure (ePCWP).
Methods: Eighty-five ESRD patients and 60 healthy individuals were enrolled in the study. Images of the LA were acquired
from apical two- and four-chamber views. The LA volumes (LAV) were calculated using the biplane area-length method.
The LA volume indices (LAVI) were calculated by dividing the LA volumes by the body surface area. The LA strain (%) (LAS)
parameters (systolic [LAS-S], early diastolic [LAS-E], late diastolic [LAS-A] during atrial contraction) were assessed, and the ePCWP
was calculated according to the following formula: ePCWP = 1.25(E/E’) + 1.9. LA stiffness was calculated non-invasively and
based on the ratio of E/E’ to LAS-S.
Results: In patients with ESRD, the LAS-S (32.22 ± 7.64% vs. 57.93 ± 8.71%; p < 0.001), LAS-E (–15.86 ± 5.7% vs. –33.37 ± 7.71%;
p < 0.001), and the LAS-A (–15.41 ± 4.16% vs. –24.57 ± 4.68%; p < 0.001) values were observed to be lower than the healthy
group; while the LA stiffness (0.4 ± 0.19 vs. 0.17 ± 0.05; p < 0.001) value was higher. When the patients with ESRD were
divided into two groups as those with a maximum LAVI value over 31.34 mL/m2 and those with a maximum LAVI below this
value, the LAS-S (30.36 ± 8.32% vs. 34.11 ± 6.43%; p = 0.023) and the LAS-E (–14.97 ± 5.88% vs. –16.76 ± 5.42%; p = 0.039)
values were lower in the group with a LAVI value over 31.34 mL/m2; while the LAS-A (–16.06 ± 4.44% vs. –14.75 ± 3.8%;
p < 0.001) and LA stiffness (0.4 ± 0.19 vs. 0.17 ± 0.05; p < 0.001) values were higher. An association was observed between
the ePCWP and LAS-S (p < 0.001), LAS-E (p = 0.01), LAS-A (p < 0.001), and LA stiffness (p < 0.001) values.
Conclusions: The results of our study have demonstrated that LA myocardial function assessed using the 2D-STE method
is associated with the ePCWP, which is an echocardiographically calculated marker of LV dysfunction. The LA deformation
parameters may be used as echocardiographic findings to predict the LV dysfunction in ESRD patients with PLVEF. Further
studies are needed to determine the independent prognostic power of the atrial strain measurement as a predictor of future
cardiovascular events in ESRD patients.
Keywords: end-stage renal diseaseleft atrial strain
