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Abstract: PO2083

Left Atrial Strain Measurements Are Associated with Cardiovascular Outcomes in Patients with ESRD

Session Information

Category: Hypertension and CVD

  • 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention


  • Dubin, Ruth F., University of California San Francisco, San Francisco, California, United States
  • Ayer, Amrita S., University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States
  • Donovan, Catherine L., University of California San Francisco, San Francisco, California, United States
  • Nelson, Lauren, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Shah, Sanjiv, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States

Left atrial (LA) strain is a marker of diastolic dysfunction, heart failure and atrial fibrillation that has been validated in populations without chronic kidney disease. There are few studies of LA strain in patients with end-stage renal disease (ESRD), among whom cardiovascular (CV) mortality is high and there are no accepted methods of CV risk stratification. We sought to examine associations of LA reservoir strain with CV hospitalization and mortality in a cohort of patients with ESRD on dialysis, and to investigate prognostic utility of strain measurements for CV outcomes.


190 ambulatory participants with ESRD on dialysis in the Cardiac, Endothelial Function and Arterial Stiffness in ESRD (CERES) study underwent 2D echocardiography at one study visit. The composite outcome, CV hospitalization or death, was adjudicated over a median of 2 years. Hospitalizations attributed to missing dialysis were not counted as events. LA and left ventricular (LV) structure and function were captured by a single technician, and de-identified images were read by a single reader using GE EchoPac software. Associations of LA reservoir strain with the composite outcome were analyzed with cox survival analyses, adjusting for age, gender, comorbidities, and systolic blood pressure.


Mean age was 56 years, 1/3 were women, and the median time since dialysis initiation was 3.5 years. 45% were diabetic and 14% had a history of heart failure. Participants were relatively euvolemic, based on well-controlled blood pressure and weight. Mean (SD) LA volume index was 40ml/m2(±12), mean LA reservoir strain was 24%(±6.9). There were 61 events: 40 hospitalizations and 21 deaths. In the adjusted model, HR (95%CI) per SD LA volume index was 1.4(1.04, 1.9); LA reservoir strain HR(95%CI) per SD was 0.67(0.47, 0.94). A risk model including age, LA reservoir strain and LV global longitudinal strain had a c-statistic(95%CI) of 0.72(0.63, 0.81) for the composite outcome.


Our results suggest that LA strain is independently associated with CV hospitalizations and death among patients with ESRD on dialysis. Strain measurements have the potential to contribute to CV risk stratification in this population. Larger studies are necessary to validate our findings.


  • NIDDK Support