Key result
Left atrial reservoir strain derived from 3DSTE was a strong independent predictor of major adverse cardiovascular events in maintenance hemodialysis patients (HR 0.69; 95% CI 0.54-0.89; p=0.004).
Why the study?
There is a paucity of literature focusing on the left atrium in patients undergoing maintenance hemodialysis.
Does left atrial reservoir strain assessed via 3DSTE predict major adverse cardiovascular events in patients undergoing maintenance hemodialysis?
Cohort (n=130)
Does left atrial reservoir strain assessed via 3DSTE predict major adverse cardiovascular events in patients undergoing maintenance hemodialysis?
Hazard Ratio: 0.69 (95% CI 0.54–0.89)
p-value: p=0.004
Left atrial reservoir strain assessed by 3DSTE is an independent predictor of MACEs in patients undergoing maintenance hemodialysis.
May aid MACE risk stratification in hemodialysis; leaves open prospective validation and clinical utility of 3DSTE strain.
Background There is a paucity of literature focusing left atrium (LA) in patients undergoing maintenance hemodialysis (MHD). Hypothesis We used three‐dimensional speckle tracking echocardiography (3DSTE) to evaluate LA in MHD patients and to explore its predictive value for adverse outcomes. Methods Echocardiography was performed on 130 consecutively enrolled MHD patients without previous cardiac diseases. Conventional and 3DSTE parameters of LA were obtained. The MHD cohort was then followed and the end point was major adverse cardiovascular events (MACEs). LA strain indices, including reservoir strain (LASr), conduit strain (LAScd), and contractile strain (LASct), were measured and compared between patients with and without MACEs. Results Patients were prospectively followed up for a median of 40.5 (interquartile range: 26.3–48.0) months. During follow‐up, 43 patients met the end point. These patients had larger LA size and reduced LA strains (LA maximal volume indexed: 45.1 ± 11.9 vs. 33.8 ± 6.9ml/m 2 ; LASr: 20.2 ± 3.5 vs. 27.2 ± 3.3%; LAScd: −12.3 ± 5.2 vs. −14.5±4.0%; LASct: −8.0 ± 4.2 vs. −13.2 ± 3.7%; all p <.05), compared with those without MACEs. Multivariable regression analysis showed LASr was the strongest predictor of MACEs (hazard ratio, 0.69; 95% confidence interval, 0.54–0.89; p =.004). Univarite Kaplan–Meier analysis revealed the incidence of MACEs in the impaired LASr (<24.2%) group was significantly higher than in the normal LASr group (log rank p <.001). Conclusions LASr derived from 3DSTE is an independent predictor of MACEs and cardiac death in MHD patients, superior to LV parameters and LA volume indices.
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Sun et al. (2022) conducted a cohort in Maintenance hemodialysis (n=130). Left atrial reservoir strain (LASr) vs. Normal LASr was evaluated on Major adverse cardiovascular events (MACEs) (HR 0.69, 95% CI 0.54-0.89, p=0.004). Left atrial reservoir strain derived from 3DSTE was a strong independent predictor of major adverse cardiovascular events in maintenance hemodialysis patients (HR 0.69; 95% CI 0.54-0.89; p=0.004).
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