Assessment Of Left Atrial Volume And Function In Patients With Chronic Kidney Disease By Three-Dimensional Echocardiography

Objective To evaluate the left atrial volume and function in patients with chronic kidney disease by three-dimensional echocardiography, and screen parameters to detect changes of left atrial in patients with CKD early.Methods 102 CKD stage2-5 patients without dialysis and 28 age and sex matched normal subjects were selected. Patients with CKD were divided into CKD2 group(CKD stage 2, 22 cases), CKD3 group(CKD stage 3, 25 cases), CKD4 group(CKD stage 4, 28 cases) and CKD5 group(CKD stage 5, 27 cases) according to the level of GFR. Routine echocardiographic parameters were measured. Full volume three-dimensional echocardiographic images were collected and analyzed by the Tom Tec offline software, and left atrial volume curve, left atrial maximal volume(LAVmax), left atrial presystolic volume(LAVp) and left atrial minimal volume(LAVmin) were acquired. After left atrial volume parameters were indexed to body surface area(BSA), the left atrial volume index(LAVI)including left atrial maximal volume index(LAVImax), left atrial presystolic volume index(LAVIp) and left atrial minimal volume index(LAVImin) were obtained. Left atrial total emptying index(LAVItotal), left atrium passive emptying index(LAVIpass), left atrial active emptying index(LAVIact), left atrial total emptying fraction(LATEF), left atrial passive emptying fraction(LAPEF) and left atrial active emptying fraction(LAAEF) were calculated. The differences of these parameters were compared.The above three-dimensional echocardiographic left atrial volume parameter reflected different left atrial function respectively. LAVImax?LAVImin?LAVIp?LAVItotal and LATEF reflected left atrial reservoir function, LAVIpass and LAPEF reflected left atrial conduit function, LAVIact and LAAEF reflected left atrial booster pump function.Results(1)Three-dimensional echocardiographic volume parameters for left atrial reservoir function: Compared with the normal group, LAVImax and LAVIp were increased in CKD groups(p<0.05), the increase in CKD4?CKD5 groups were significant. LAVImin in CKD4 and CKD5 groups were higher than that of normal?CKD2 and CKD3 groups(p<0.05). LAVTtotal?LATEF in CKD4 and CKD5 groups were higher than that of normal group(p<0.05).(2)Three-dimensional echocardiographic volume parameters for left atrial conduit function: Compared with the normal group, LAPEF was decreased in all CKD groups(p<0.05), the decrease in CKD5 group was significant. There was no significant difference of LAVIpass between groups(p>0.05).(3)Three-dimensional echocardiographic volume parameters for left atrial booster pump function: Compared with the normal group, LAVIact was decreased in all CKD groups(p<0.05), the decrease in CKD5 group was significant. There was no significant difference of LAAEF between groups(p>0.05).Conclusions(1)The left atrial volume index, reservoir function, booster pump function were increased and conduit function was decreased in CKD 2-5 stages patients.(2)Three-dimensional echocardiography could assess the changes of left atrial structure and function in patients with CKD early. LAVImax?LAVIp could predict the change of left atrial reserve function earlier than LAVImin?LAVItotal and LATEF in patients with CKD. LAAEF?LAPEF could detect the early change of left atrial conduit function and booster pump function in patients with CKD respectively.