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


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.


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


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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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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