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The International Journal of Cardiovascular Imaging

, Volume 34, Issue 9, pp 1393–1401 | Cite as

Left atrial deformation as a potent predictor for paroxysmal atrial fibrillation in patients with end-stage renal disease

  • Christodoulos E. PapadopoulosEmail author
  • Efstathios Pagourelias
  • Constantinos Bakogiannis
  • Konstantinos Triantafyllou
  • Konstantinos Baltoumas
  • Efstratios Kassimatis
  • Dimitrios Zioutas
  • Dimitrios Siskos
  • Stergios Tzikas
  • Nikolaos Fragakis
  • Aikaterini Papagianni
  • Vassilios Vassilikos
Original Paper
  • 107 Downloads

Abstract

It is widely known that various factors contribute to left atrial (LA) mechanical dysfunction in patients with end stage renal disease (ESRD). However, the connection between atrial dysfunction and arrhythmic events such as paroxysmal atrial fibrillation (PAF), in this group of patients, remains unclear. The purpose of our study was to evaluate prospectively the association between LA deformation indices and PAF in ESRD patients. 79 patients (41 men, mean age 57 ± 17) with ESRD and preserved left ventricular systolic function comprised the study population. All patients underwent a baseline comprehensive echocardiography study and were followed for a mean period of 16 ± 5 months. PAF episodes, first and the following events, were reported. LA longitudinal strain reflecting LA reservoir function and LA longitudinal strain rate reflecting LA pump function were specifically evaluated as LA deformation indices of interest, using 2D speckle tracking echocardiography. At the end of follow up period nine patients died. 15 of the rest 70 reported one or more episodes of PAF. LA indexed volumes were significantly higher in patients with PAF (32 ± 26 vs. 21.5 ± 9 ml/m2, p = 0.002), mean LA strain was significantly reduced (17 ± 7 vs. 27 ± 9%, p < 0.001) as well as mean LA stain rate (− 1.19 ± 0.5 vs. − 1.95 ± 0.5 1/s, p < 0.001). Multivariate analysis showed that LA strain rate when adjusted with age together with PAF history remained the single most significant echocardiographic parameter for PAF prediction. Impaired LA strain and LA strain rate are associated with PAF in ESRD patients. LA strain rate might be a better independent predictor of PAF, compared to standard echocardiographic indices. Further prospective studies are needed to validate its relevance in routine clinical practice.

Keywords

Atrial fibrillation 2D speckle tracking Left atrium Strain Strain rate Renal failure 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener HC, Heidbuchel H, Hendriks J, Hindricks G, Manolis AS, Oldgren J, Popescu BA, Schotten U, Van Putte B, Vardas P (2016) 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 37(38):2893–2962.  https://doi.org/10.1093/eurheartj/ehw210 CrossRefPubMedGoogle Scholar
  2. 2.
    Donal E, Behagel A, Feneon D (2015) Value of left atrial strain: a highly promising field of investigation. Eur Heart J Cardiovasc Imaging 16(4):356–357.  https://doi.org/10.1093/ehjci/jeu230 CrossRefPubMedGoogle Scholar
  3. 3.
    Morris DA, Takeuchi M, Krisper M, Kohncke C, Bekfani T, Carstensen T, Hassfeld S, Dorenkamp M, Otani K, Takigiku K, Izumi C, Yuda S, Sakata K, Ohte N, Tanabe K, Osmanoglou E, Kuhnle Y, Dungen HD, Nakatani S, Otsuji Y, Haverkamp W, Boldt LH (2015) Normal values and clinical relevance of left atrial myocardial function analysed by speckle-tracking echocardiography: multicentre study. Eur Heart J Cardiovasc Imaging 16(4):364–372.  https://doi.org/10.1093/ehjci/jeu219 CrossRefPubMedGoogle Scholar
  4. 4.
    Winkelmayer WC, Patrick AR, Liu J, Brookhart MA, Setoguchi S (2011) The increasing prevalence of atrial fibrillation among hemodialysis patients. J Am Soc Nephrol 22(2):349–357.  https://doi.org/10.1681/ASN.2010050459 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Black-Maier E, Piccini JP (2017) Oral anticoagulation in end-stage renal disease and atrial fibrillation: is it time to just say no to drugs? Heart 103(11):807–808.  https://doi.org/10.1136/heartjnl-2016-310540 CrossRefPubMedGoogle Scholar
  6. 6.
    Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener HC, Heidbuchel H, Hendriks J, Hindricks G, Manolis AS, Oldgren J, Popescu BA, Schotten U, Van Putte B, Vardas P, Agewall S, Camm J, Baron Esquivias G, Budts W, Carerj S, Casselman F, Coca A, De Caterina R, Deftereos S, Dobrev D, Ferro JM, Filippatos G, Fitzsimons D, Gorenek B, Guenoun M, Hohnloser SH, Kolh P, Lip GY, Manolis A, McMurray J, Ponikowski P, Rosenhek R, Ruschitzka F, Savelieva I, Sharma S, Suwalski P, Tamargo JL, Taylor CJ, Van Gelder IC, Voors AA, Windecker S, Zamorano JL, Zeppenfeld K (2016) 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace 18(11):1609–1678.  https://doi.org/10.1093/europace/euw295 CrossRefPubMedGoogle Scholar
  7. 7.
    Galderisi M, Cosyns B, Edvardsen T, Cardim N, Delgado V, Di Salvo G, Donal E, Sade LE, Ernande L, Garbi M, Grapsa J, Hagendorff A, Kamp O, Magne J, Santoro C, Stefanidis A, Lancellotti P, Popescu B, Habib G (2017) Standardization of adult transthoracic echocardiography reporting in agreement with recent chamber quantification, diastolic function, and heart valve disease recommendations: an expert consensus document of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 18(12):1301–1310.  https://doi.org/10.1093/ehjci/jex244 CrossRefPubMedGoogle Scholar
  8. 8.
    Hirose T, Kawasaki M, Tanaka R, Ono K, Watanabe T, Iwama M, Noda T, Watanabe S, Takemura G, Minatoguchi S (2012) Left atrial function assessed by speckle tracking echocardiography as a predictor of new-onset non-valvular atrial fibrillation: results from a prospective study in 580 adults. Eur Heart J Cardiovasc Imaging 13(3):243–250.  https://doi.org/10.1093/ejechocard/jer251 CrossRefPubMedGoogle Scholar
  9. 9.
    Montserrat S, Gabrielli L, Bijnens B, Borras R, Berruezo A, Poyatos S, Brugada J, Mont L, Sitges M (2015) Left atrial deformation predicts success of first and second percutaneous atrial fibrillation ablation. Heart Rhythm 12(1):11–18.  https://doi.org/10.1016/j.hrthm.2014.08.032 CrossRefPubMedGoogle Scholar
  10. 10.
    Yasuda R, Murata M, Roberts R, Tokuda H, Minakata Y, Suzuki K, Tsuruta H, Kimura T, Nishiyama N, Fukumoto K, Aizawa Y, Tanimoto K, Takatsuki S, Abe T, Fukuda K (2015) Left atrial strain is a powerful predictor of atrial fibrillation recurrence after catheter ablation: study of a heterogeneous population with sinus rhythm or atrial fibrillation. Eur Heart J Cardiovasc Imaging 16(9):1008–1014.  https://doi.org/10.1093/ehjci/jev028 PubMedCrossRefGoogle Scholar
  11. 11.
    Altekin RE, Yanikoglu A, Karakas MS, Ozel D, Yilmaz H, Demir I (2013) Evaluation of left atrial function using two-dimensional speckle tracking echocardiography in end-stage renal disease patients with preserved left ventricular ejection fraction. Kardiol Pol 71(4):341–351.  https://doi.org/10.5603/KP.2013.0061 CrossRefPubMedGoogle Scholar
  12. 12.
    Calleja AM, Rakowski H, Williams LK, Jamorski M, Chan CT, Carasso S (2016) Left atrial and ventricular systolic and diastolic myocardial mechanics in patients with end-stage renal disease. Echocardiography 33(10):1495–1503.  https://doi.org/10.1111/echo.13284 CrossRefPubMedGoogle Scholar
  13. 13.
    Mathew JS, Sachs MC, Katz R, Patton KK, Heckbert SR, Hoofnagle AN, Alonso A, Chonchol M, Deo R, Ix JH, Siscovick DS, Kestenbaum B, de Boer IH (2014) Fibroblast growth factor-23 and incident atrial fibrillation: the Multi-Ethnic Study of Atherosclerosis (MESA) and the Cardiovascular Health Study (CHS). Circulation 130(4):298–307.  https://doi.org/10.1161/CIRCULATIONAHA.113.005499 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Nowak A, Friedrich B, Artunc F, Serra AL, Breidthardt T, Twerenbold R, Peter M, Mueller C (2014) Prognostic value and link to atrial fibrillation of soluble klotho and FGF23 in hemodialysis patients. PLoS ONE 9(7):e100688.  https://doi.org/10.1371/journal.pone.0100688 CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Allessie M, Ausma J, Schotten U (2002) Electrical, contractile and structural remodeling during atrial fibrillation. Cardiovasc Res 54(2):230–246CrossRefPubMedGoogle Scholar
  16. 16.
    Vieira MJ, Teixeira R, Goncalves L, Gersh BJ (2014) Left atrial mechanics: echocardiographic assessment and clinical implications. J Am Soc Echocardiogr 27(5):463–478.  https://doi.org/10.1016/j.echo.2014.01.021 CrossRefPubMedGoogle Scholar
  17. 17.
    Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 16(3):233–270.  https://doi.org/10.1093/ehjci/jev014 CrossRefPubMedGoogle Scholar
  18. 18.
    Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T, Flachskampf FA, Gillebert TC, Klein AL, Lancellotti P, Marino P, Oh JK, Alexandru Popescu B, Waggoner AD (2016) Recommendations for the Evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 17(12):1321–1360.  https://doi.org/10.1093/ehjci/jew082 CrossRefPubMedGoogle Scholar
  19. 19.
    Mor-Avi V, Lang RM, Badano LP, Belohlavek M, Cardim NM, Derumeaux G, Galderisi M, Marwick T, Nagueh SF, Sengupta PP, Sicari R, Smiseth OA, Smulevitz B, Takeuchi M, Thomas JD, Vannan M, Voigt JU, Zamorano JL (2011) Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. Eur J Echocardiogr 12(3):167–205.  https://doi.org/10.1093/ejechocard/jer021 CrossRefPubMedGoogle Scholar
  20. 20.
    Tan TC, Koutsogeorgis ID, Grapsa J, Papadopoulos C, Katsivas A, Nihoyannopoulos P (2014) Left atrium and the imaging of atrial fibrosis: catch it if you can! Eur J Clin Investig 44(9):872–881.  https://doi.org/10.1111/eci.12305 CrossRefGoogle Scholar
  21. 21.
    Floege J, Fliser D (2015) Klotho deficiency and the cardiomyopathy of advanced CKD. J Am Soc Nephrol 26(6):1229–1231.  https://doi.org/10.1681/ASN.2014090951 CrossRefPubMedGoogle Scholar
  22. 22.
    Rotondi S, Pasquali M, Tartaglione L, Muci ML, Mandanici G, Leonangeli C, Sales S, Farcomeni A, Mazzaferro S (2015) Soluble alpha -Klotho serum levels in chronic kidney disease. Int J Endocrinol 2015:872193.  https://doi.org/10.1155/2015/872193 CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Girasis C, Vassilikos V, Efthimiadis GK, Papadopoulou SL, Dakos G, Dalamaga EG, Chouvarda I, Giannakoulas G, Kamperidis V, Paraskevaidis S, Maglaveras N, Karvounis HI, Parcharidis GE, Styliadis IH (2013) Patients with hypertrophic cardiomyopathy at risk for paroxysmal atrial fibrillation: advanced echocardiographic evaluation of the left atrium combined with non-invasive P-wave analysis. Eur Heart J Cardiovasc Imaging 14(5):425–434.  https://doi.org/10.1093/ehjci/jes172 CrossRefPubMedGoogle Scholar
  24. 24.
    Motoki H, Negishi K, Kusunose K, Popovic ZB, Bhargava M, Wazni OM, Saliba WI, Chung MK, Marwick TH, Klein AL (2014) Global left atrial strain in the prediction of sinus rhythm maintenance after catheter ablation for atrial fibrillation. J Am Soc Echocardiogr 27(11):1184–1192.  https://doi.org/10.1016/j.echo.2014.08.017 CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Yoon YE, Oh IY, Kim SA, Park KH, Kim SH, Park JH, Kim JE, Lee SP, Kim HK, Kim YJ, Sohn DW, Cho GY (2015) Echocardiographic Predictors of Progression to Persistent or Permanent Atrial Fibrillation in Patients with Paroxysmal Atrial Fibrillation (E6P Study). J Am Soc Echocardiogr 28(6):709–717.  https://doi.org/10.1016/j.echo.2015.01.017 CrossRefPubMedGoogle Scholar
  26. 26.
    Kadappu KK, Abhayaratna K, Boyd A, French JK, Xuan W, Abhayaratna W, Thomas L (2016) Independent echocardiographic markers of cardiovascular involvement in chronic kidney disease: the value of left atrial function and volume. J Am Soc Echocardiogr 29(4):359–367.  https://doi.org/10.1016/j.echo.2015.11.019 CrossRefPubMedGoogle Scholar
  27. 27.
    Unger ED, Dubin RF, Deo R, Daruwalla V, Friedman JL, Medina C, Beussink L, Freed BH, Shah SJ (2016) Association of chronic kidney disease with abnormal cardiac mechanics and adverse outcomes in patients with heart failure and preserved ejection fraction. Eur J Heart Fail 18(1):103–112.  https://doi.org/10.1002/ejhf.445 CrossRefPubMedGoogle Scholar
  28. 28.
    Patel NJ, Patel A, Agnihotri K, Pau D, Patel S, Thakkar B, Nalluri N, Asti D, Kanotra R, Kadavath S, Arora S, Patel N, Sheikh A, Badheka AO, Deshmukh A, Paydak H, Viles-Gonzalez J (2015) Prognostic impact of atrial fibrillation on clinical outcomes of acute coronary syndromes, heart failure and chronic kidney disease. World J Cardiol 7(7):397–403.  https://doi.org/10.4330/wjc.v7.i7.397 CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Lu YY, Cheng CC, Chen YC, Lin YK, Chen SA, Chen YJ (2016) Electrolyte disturbances differentially regulate sinoatrial node and pulmonary vein electrical activity: a contribution to hypokalemia- or hyponatremia-induced atrial fibrillation. Heart Rhythm 13(3):781–788.  https://doi.org/10.1016/j.hrthm.2015.12.005 CrossRefPubMedGoogle Scholar
  30. 30.
    Tsang TS, Abhayaratna WP, Barnes ME, Miyasaka Y, Gersh BJ, Bailey KR, Cha SS, Seward JB (2006) Prediction of cardiovascular outcomes with left atrial size: is volume superior to area or diameter? J Am Coll Cardiol 47(5):1018–1023.  https://doi.org/10.1016/j.jacc.2005.08.077 CrossRefPubMedGoogle Scholar
  31. 31.
    Boos CJ, Anderson RA, Lip GY (2006) Is atrial fibrillation an inflammatory disorder? Eur Heart J 27(2):136–149.  https://doi.org/10.1093/eurheartj/ehi645 CrossRefPubMedGoogle Scholar
  32. 32.
    Pena JM, MacFadyen J, Glynn RJ, Ridker PM (2012) High-sensitivity C-reactive protein, statin therapy, and risks of atrial fibrillation: an exploratory analysis of the JUPITER trial. Eur Heart J 33(4):531–537.  https://doi.org/10.1093/eurheartj/ehr460 CrossRefPubMedGoogle Scholar
  33. 33.
    Nakai K, Komaba H, Fukagawa M (2010) New insights into the role of fibroblast growth factor 23 in chronic kidney disease. J Nephrol 23(6):619–625PubMedGoogle Scholar
  34. 34.
    Rebholz CM, Grams ME, Coresh J, Selvin E, Inker LA, Levey AS, Kimmel PL, Vasan RS, Eckfeldt JH, Feldman HI, Hsu CY, Lutsey PL (2015) Serum fibroblast growth factor-23 is associated with incident kidney disease. J Am Soc Nephrol 26(1):192–200.  https://doi.org/10.1681/ASN.2014020218 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  • Christodoulos E. Papadopoulos
    • 1
    Email author
  • Efstathios Pagourelias
    • 1
  • Constantinos Bakogiannis
    • 1
  • Konstantinos Triantafyllou
    • 1
  • Konstantinos Baltoumas
    • 1
  • Efstratios Kassimatis
    • 2
  • Dimitrios Zioutas
    • 3
  • Dimitrios Siskos
    • 4
  • Stergios Tzikas
    • 1
  • Nikolaos Fragakis
    • 1
  • Aikaterini Papagianni
    • 2
  • Vassilios Vassilikos
    • 1
  1. 1.3rd Cardiology Department, Hippokrateio University HospitalAristotle University of ThessalonikiThessalonikiGreece
  2. 2.Nephrology Department, Hippokrateio University HospitalAristotle University of ThessalonikiThessalonikiGreece
  3. 3.Cardiology DepartmentSt. Luke’s HospitalThessalonikiGreece
  4. 4.Department of Cardiothoracic Surgery, Heart CenterUniversity Hospital Cologne, CologneCologneGermany

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