Impact of chronic kidney disease on left ventricular and left atrial structure and function in STEMI patients treated with primary PCI: a comprehensive echocardiographic analysis

Abstract Background Chronic kidney disease (CKD) is associated with adverse cardiovascular remodeling. In patients with ST-segment elevation myocardial infarction (STEMI), these changes may further impact post-infarction recovery and prognosis. While LVEF remains a key metric, it does not fully capture subclinical myocardial dysfunction, which may be more pronounced in CKD patients. Objective To assess the impact of CKD on LV and LA structure and function in STEMI patients treated with primary PCI, using conventional and advanced echocardiographic parameters. Methods This prospective study included STEMI patients, categorized by chronic kidney disease (CKD) - known history of CKD or estimated glomerular filtration rate at admission 60 mL/min/1.73 m2. Echocardiographic assessment was performed at discharge (Vivid E95i, EchoPAC v206) according to EACVI guidelines. LV structure and function were assessed using LV end-systolic volume index (ESVi), LV mass index (LVMi), ejection fraction (EF), global longitudinal strain (LV GLS), and myocardial work indices: global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE). Diastolic function was assessed by E/E′ avg, while LA structure and function were evaluated using LA volume index (LAVi), and LA strain indices (LAS-r, LAS-cd, LAS-c). Results A total of 385 patients with first STEMI, successfully treated with pPCI, were included and 44 (11.4%) patients had CKD. Results are summarized in Table 1. While LV structural parameters and EF were similar between groups, CKD patients had significantly increased LAVi (p = 0.001), suggesting early LA remodeling. LV GLS was reduced in CKD patients (p = 0.026), indicating subclinical systolic dysfunction. Although LV GWI and GCW were comparable between groups, GWW was significantly higher in CKD patients (p = 0.002), suggesting greater myocardial inefficiency. Additionally, LV GWE was significantly lower in CKD patients (p = 0.007), reflecting impaired myocardial energy utilization. Diastolic dysfunction was more pronounced in CKD patients, as demonstrated by a higher E/E′ avg (p 0.001), suggesting elevated LV filling pressures. Furthermore, right ventricular systolic pressure (RVSP) was markedly higher in CKD patients (p 0.001), indicating increased pulmonary vascular resistance. LA function was significantly impaired in CKD patients, with reduced LAS-r (p 0.001), LAS-cd (p = 0.013), and LAS-c (p = 0.004), suggesting both impaired reservoir and contractile function. These findings highlight LA dysfunction as a key component of cardiovascular impairment in CKD patients post-STEMI. Table 1 summarizes these findings. Conclusion These findings suggest that LA strain and myocardial work indices provide valuable insights beyond conventional echocardiography in this CKD population, emphasizing the need for early detection and targeted therapeutic strategies to optimize post-infarction outcomes.