Left Atrial Volume as a Biomarker of Target Organ Damage in Cardionephrology: A Study in a Wide Range of Renal Function

Zach Rozenbaum*, Orit Kliuk Ben-Bassat, Yitzhak Hadad, Moshe Iluz, Yoav Granot, Tomer Ziv-Baran, Shlomo Berliner, Galit Aviram

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Cardiac chamber size was previously studied by echocardiography, among patients with progressive kidney disease only. We aimed to explore the relations between all heart chamber volumes as assessed by CT pulmonary angiography and renal function, throughout all ranges. Methods: Using a novel technology for automatic four-chamber volumetric analysis, we analyzed CT pulmonary angiography results for 748 consecutive patients (between January 1 and December 31, 2014) without pulmonary embolism, and correlated the chamber volumes, indexed to body surface area, with the estimated glomerular filtration rates (eGFRs). Results: After adjustment for age, all cardiac chamber volumes aside from that of the left ventricle inversely correlated with the eGFR. For every 10-unit decrease in eGFR, the volume indices of the left atrium, right atrium, and right ventricle were larger by 3.1%, 2.3%, and 1.5% (P <.001, P =.003, P =.007), respectively. There was a significant correlation between left atrial volume index and eGFR (r = −0.43; P <.001). In a categorical comparison, patients with even minimal renal dysfunction (eGFR, 60 to 90 mL/min/1.73 m2) had a 10.3% larger left atrial volume index (95% CI, 3.1-17.9; P =.004) compared to patients with an eGFR > 90 mL/min/1.73 m2. Conclusions: A simple concomitant volumetric analysis of all four cardiac chambers by CT pulmonary angiography demonstrated that differences in volume correlate with renal function even within the normal range spectrum. The difference was most evident in the left atrium. This finding may be the first clue to evolving cardiorenal syndrome and may serve as a target for early therapeutic interventions. Trial Registry: ClinicalTrials.gov; Clinical Trials registration number (Helsinki Committee): 0603-15-TLV; URL: www.clinicaltrials.gov.

Original languageEnglish
Pages (from-to)893-903
Number of pages11
JournalChest
Volume154
Issue number4
DOIs
StatePublished - Oct 2018

Keywords

  • cardiorenal syndrome
  • chambers
  • left atrial volume index
  • target organ damage
  • volumetry

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