Prognostic values of left atrial strain analyzed by the dedicated four-dimensional speckle-tracking echocardiography in end-stage renal disease patients with preserved left ventricular ejection fraction

Abstract

Abstract Background Little is known about the prognostic value of left atrial strain by four-dimensional speckle-tracking echocardiography in end-stage renal disease(ESRD) patients with preserved left ventricular ejection fraction(LVEF). Methods This prospective study collected clinical and echocardiographic data from 80 stable dialysis patients (mean age 57 ± 10 years; 62.5% men). All patients underwent the dedicated four-dimensional speckle-tracking echocardiography to measure LASr (peak longitudinal strain of reservoir function), LAScd (peak longitudinal strain of conduit function), LASct (peak longitudinal strain of contractile function), LASr_c (peak circumferential strain of reservoir function), LAScd_c (peak circumferential strain of conduit function) and LASct_c (peak circumferential strain of contractile function). These patients were enrolled from August 2021 to August 2023 and followed-up for 19months (interquartile-range 15 to 20months). The primary outcome was a composite of all-cause mortality or major adverse cardiovascular events (MACEs). The study patients were classified into event (developed mortality or MACEs) and event-free group according to the primary outcome. Multivariate Cox regression analysis was used to investigate risk factors for all-cause mortality or MACEs. Results The event group had lower LASr (16.4% vs. 21.2%, P = 0.0003), LASct (8.2% vs.11.2%, P = 0.01), LASr_c (25.2% vs.35.0%, P = 0.0004) and LASct_c (14.9%vs. 20.9%, P = 0.001) than the event-free group. Using the mean left atrial strain value as a cutoff, the less LASr (LASr < 20.2%), LASr_c (LASr_c < 32.9%), and LASct_c (LASct_c < 19.6%)group had a higher mortality or MACEs rate. Multivariate cox regression analyses revealed that LASr (HR = 0.81, 95% CI [0.17; 0.91], P = 0.0005, per 1% increase) and LASr_c (HR = 0.93, 95% CI [0.87; 0.98], p = 0.01, per 1% increase) were independent predictors of all-cause mortality or MACEs. Conclusions Less peak longitudinal and circumferential strains of reservoir function are predictive of poor prognosis among end-stage renal disease patients with preserved left ventricular ejection fraction.