Left atrial energy loss as a novel predictor of mortality and cardiovascular events in chronic kidney disease patients with preserved ejection fraction

Patients with chronic kidney disease (CKD) have an increased risk of cardiovascular adverse events and abnormal intracardiac blood flow, which are commonly underestimated when evaluated by traditional echocardiographic parameters. Energy loss (EL), a novel Vector Flow Mapping (VFM) -based parameter, enables early hemodynamic assessment of cardiac dysfunction. This study sought to explore whether EL of left atrial has prognostic value for cardiovascular risk in CKD patients with preserved ejection fraction. A total of 137 prospectively recruited patients with CKD in stages 3-5 and normal left ventricular ejection fraction (LVEF) (67% male, mean age 50.74 ± 13.23 years) underwent measurement of left atrial energy loss (LAEL) within three cardiac cycles, using VFM technology. Participants were followed up for an average of 5.11 ± 1.50 years, with the primary endpoints being all-cause mortality and major adverse cardiovascular events (MACE). Major endpoint events occurred in 46 cases (34%). Mean LAEL (M-LAEL) was significantly higher in patients with adverse events than in those without. M-LAEL (hazard ratio [HR]: 2.84, 95% confidence interval [CI]: 1.97-4.09) was identified as an independent predictor of the major endpoint. An increase in M-LAEL (≥ 2.05 × 10- 3 J/m · s) was associated with a higher risk of all-cause mortality and MACE (log rank χ² = 26.94; P < 0.001). The DeLong test indicated that M-LAEL (area under the curve [AUC] = 0.845) outperformed LAVI (AUC = 0.712), LVMI (AUC = 0.739), and LEDV (AUC = 0.717) in predicting adverse events. M-LAEL demonstrated robust predictive power for overall mortality and MACE in CKD, highlighting its potential for early cardiovascular risk stratification and timely intervention in this population.