261 - Left Atrial Mechanics in Youth with Moderate Chronic Kidney Disease

Asymptomatic left Ventricular Diastolic Dysfunction (LVDD) is a common echocardiographic finding in adults with CKD and precedes the development of symptomatic heart failure. In adults with CKD, abnormal left atrial mechanics, especially left atrial reservoir strain (LASr), are often the earliest indicator of LVDD and may represent a reversible stage of subclinical disease. However, left atrial mechanics are understudied in youth with CKD. 

Objective: The objective of this study was to assess measures of left atrial strain (LAS) in youth with CKD and test their correlation with traditional measures of diastolic dysfunction (mitral inflow velocities [E/A, E/e’]).

Design/Methods:

We performed a retrospective, observational study of persons aged 12-25 years who carried a diagnosis of stage 4 CKD (eGFR by CKiD U25: 15-30mL/min/1.73m²) at our institution and had available echocardiographic images. Exclusion criteria included a history of a kidney or other solid organ transplant, congenital heart disease, and/or dialysis requirement < 3 months prior. Echocardiographic images were interpreted by a pediatric cardiologist to collect: LAS (LASr, conduit, and contractile strain), E/e’ (lateral and septal e’), E/A, left ventricular mass index (LVMI), and ejection fraction. Spearman correlations were performed between echocardiographic measures.

Results:

In total, 18 patients had available images for interpretation. Mean age was 16 ±2 years, 78% were male, mean eGFR was 22 ±6.2mL/min/1.73m², and mean LVMI was 39.2 ±12.2g/m². Mean LASr was 45.7 ±10.4%, and was significantly correlated with LAS_conduit (R=-0.74) and LAS_contractile (R=-0.64) and was not significantly correlated with eGFR (p=0.98). All measures of LAS poorly correlated with traditional measures of LVDD, including E/e’ and E/A (Figure 1).  

Conclusion(s):

Measures of left atrial mechanics, notably LASr, were poorly correlated with traditional measures of LVDD (E/e’ and E/A) and be used to construct a distinct phenotype of diastolic dysfunction in youth with CKD. Additionally, the mean LASr in our cohort was lower than published values derived in healthy adolescents aged 11-18 years (CKD: 45.7±10.4 vs. Healthy: 57.6±10.5). Further studies are required to test whether LASr changes at earlier stages of LVDD than E/e’ or E/A, as observed in adults with CKD. Ongoing analyses include measuring left atrial mechanics in a larger subset of pediatric CKD, including those with Stage 2 and 3 CKD, and healthy, age-matched controls.


DD Correlations.jpeg