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Left atrial dilatation and ST-T changes predict cardiovascular outcome in chronic hemodialysis patients

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Abstract

The left atrium (LA) is afterload-sensitive, meaning that it responds to changes in left ventricular diastolic pressure, and left atrial volumetric remodeling has been reported. We prospectively examined the effects of LA enlargement and ST-T changes on cardiovascular outcome of chronic hemodialysis (HD) patients. Echocardiography was performed twice, a mean interval of 2.1 ± 0.4 years apart, and LA size, left ventricular mass index (LVMI), and other indices were evaluated. The prognostic value of ST-T changes and LA dilatation for cardiovascular events was investigated in a cohort of 112 HD patients. The LVDd, interventricular septum thickness, fractional shortening, and LVMI values were higher in the HD patients with ST-T changes and LA dilatation at the second echocardiography. Moreover, LV hypertrophy (LVH) and new cardiovascular events were more common in HD patients with both ST-T changes and LA dilatation (p = 0.0127). Interdialysis weight gain, presence of ST-T changes and LA dilatation, and use of calcium channel blockers were significantly associated with LVH, and the odds ratios were 1.740, 2.870, and 0.304, respectively. Over a mean follow-up period of 2.1 ± 0.4 years, 27 patients experienced new cardiovascular event. A Cox proportional hazard analysis revealed that complication of coronary artery diseases, the presence of ST-T changes and LA dilatation, and serum albumin levels were significantly associated with incident cardiovascular events, and the hazard ratios were 3.898, 5.182, and 0.185 (1 g/dl per year increase), respectively. In a Kaplan–Meier analysis, incident cardiovascular events were significantly less common in HD patients without ST-T changes and LA dilatation than those with (p < 0.0001), 50% event-free period was about 2 years in HD patients with ST-T changes and LA dilatation. In conclusion, ST-T changes and LA dilatation predict the cardiovascular outcome of chronic HD patients. Detecting ST-T changes on ECG and LA dilatation is useful for monitoring cardiovascular risk in chronic HD patients.

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Acknowledgments

We thank medical staffs for dialysis Units in the Yoshikawa Hospital for collecting medical records. This work was supported by grants from the Japan Research Promotion Society for Cardiovascular Diseases the International Research.

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Authors and Affiliations

  1. Department of Medicine, Tokyo Women’s Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan

    Kiyotsugu Omae & Tetsuya Ogawa

  2. Yoshikawa Hospital, Tokyo, Japan

    Kiyotsugu Omae & Masao Yoshikawa

  3. Department of Internal Medicine, Kidney Center, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Kosaku Nitta

Authors
  1. Kiyotsugu Omae
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  2. Tetsuya Ogawa
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  3. Masao Yoshikawa
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  4. Kosaku Nitta
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Correspondence to Tetsuya Ogawa.

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Omae, K., Ogawa, T., Yoshikawa, M. et al. Left atrial dilatation and ST-T changes predict cardiovascular outcome in chronic hemodialysis patients. Heart Vessels 27, 610–617 (2012). https://doi.org/10.1007/s00380-011-0189-2

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  • DOI: https://doi.org/10.1007/s00380-011-0189-2

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