Left Atrial Enlargement: An Unfavorable Cardiorenal Omen

Chronic kidney disease (CKD) is a major public health problem worldwide, and cardiovascular disease remains the leading cause of morbidity and mortality among patients with CKD (1). The cardiovascular mortality risk is demonstrable at each stage of CKD due to both traditional risk factors and those specific to kidney disease. There has been rapidly growing interest in the past decade in the relation between heart and kidney dysfunctions, popularly termed “cardiorenal syndrome” (2). The cardiac alterations develop early during the course of CKD, attributed mainly to volume and pressure overloads associated with a variety of metabolic and neurohumoral abnormalities. Accordingly, pathologic cardiac remodeling, including cellular, structural and functional changes, is frequently identified in patients with CKD, and associated with disease progression and poor prognosis (1, 3). Echocardiography is an established non-invasive method for estimating the risk for cardiovascular complications and for guiding treatment of CKD patients. It is particularly helpful in risk stratification and monitoring (4, 5). Several left ventricular (LV) structural and functional parameters, such as the left ventricular mass index (LVMI), ejection fraction (LVEF) and LV chamber volume, have been shown to be valuable prognosticators of cardiovascular events and adverse outcomes in CKD patients (4-6). Although less well studied than LV abnormalities, an enlarged left atrium (LA) has recently been identified as another useful indicator for unfavorable cardiovascular outcomes in various pathologic conditions, including atrial fibrillation, stroke, heart failure, cardiovascular and all-cause mortality (7-9). The LA mechanical function, in a close interdependence with LV, plays a key role in maintaining Editorial Comments