Evaluation of left atrial function using four-dimensional volume-strain in end-stage renal disease patients with preserved left ventricular ejection fraction

Objective: The purpose of this study was to investigate alterations in routine echocardiographic parameters and left atrial(LA) strains in normal LA and large LA groups in end-stage renal disease(ESRD) patients. Methods: Thirty-five age-matched healthy individuals and 82 patients with ESRD, including 52 with LA maximum volume index(LAVmax I)＜34 ml/m2 (normal LA group)and 30 with LAVmax I≥34 ml/m2 (large LA group), were enrolled. LA volumes and longitudinal and circumferential strains were measured using 4-dimensional(D) volume-strain technology. Results: Left ventricular(LV) wall thickness, the Left ventricular mass index(LVMI), peak early diastolic trans-mitral flow velocity/average peak early diastolic mitral annular velocity(E/ E’), and peak systolic dispersion(PSD) were higher in normal LA and large LA group compared with the control group. Mitral valve early diastolic velocity/mitral valve late diastolic velocity(E/A), the early diastolic velocity at the septal mitral annulus(E’ septal), the early diastolic velocity at the lateral mitral annulus (E’ lateral), global longitudinal strain(GLS), left atrial peak longitudinal strain of reservoir function (LASr) and left atrial peak longitudinal strain of conduit function(LAScd) were lower in normal LA and large LA group compared with the control group. Left atrial peak circumferential strain of reservoir function(LASr-c) and left atrial peak circumferential strain of contractile function(LASct-c) were lower in the large LA group compared with the control group. In ESRD patients, LASr-c and LASct-c showed a good correlation with LAVmax I. Conclusions: This study showed that LA longitudinal strains had decreased before LA enlargement. When LA enlargement occurred, the circumferential strains decreased. This may indicate that longitudinal strain changed earlier than circumferential strain in ESRD patients.