Evaluation of left atrial appendage functions by transthoracic echocardiography and comparison with left atrial strain values in renal transplant candidates

Abstract

Aim: The incidence of stroke in patients with chronic kidney disease (CKD) is increased independent of atrial arrhythmias. The goal of this study is to evaluate, left atrial appendage (LAA) functions by transthoracic echocardiography (TTE) and comparison with left atrial (LA) strain values in patients with in renal transplant candidates with end stage renal disease (ESRD) with sinus rhythm. Material and Methods: Fifty two renal transplant candidates and 60 age- and sex-matched healthy participants were included in the study. LAA emptying velocity (EV) was measured with pulse wave Doppler, early diastolic (LAA Em), contraction (LAA Am) and systolic (LAA Sm) velocities were measured using tissue Doppler imaging from parasternal short axis view. Atrial peak longitudinal strain (PLS), peak contraction strain (PCS) and conduit strain (CdS) were calculated using two dimensional speckle tracking echocardiography. Results: LAA EV, Am and Sm and LA PLS, PCS, CdS measurements were found to be significantly lower in the patient group compared to controls. LAA EV measurements showed a strong positive correlation with left atrial volume index (LAVI), LA PLS and LA PCS values, and a negative correlation with left ventricular (LV) diameters, and E/e' value. In the multivariate regression analysis LA PLS and LAVI were found to be independent factors for LAA EV. Conclusion: Our findings suggest that the evaluation of LAA functions with TTE may help determine the increased risk of developing atrial arrhythmias and ischemic stroke in renal transplant candidates. Supporting the current findings with larger studies may change the follow-up and treatment approaches in these patients. / Aim: The incidence of stroke in patients with chronic kidney disease (CKD) is increased independent of atrial arrhythmias. The goal of this study is to evaluate, left atrial appendage (LAA) functions by transthoracic echocardiography (TTE) and comparison with left atrial (LA) strain values in patients with in renal transplant candidates with end stage renal disease (ESRD) with sinus rhythm. Material and Methods: Fifty two renal transplant candidates and 60 age- and sex-matched healthy participants were included in the study. LAA emptying velocity (EV) was measured with pulse wave Doppler, early diastolic (LAA Em), contraction (LAA Am) and systolic (LAA Sm) velocities were measured using tissue Doppler imaging from parasternal short axis view. Atrial peak longitudinal strain (PLS), peak contraction strain (PCS) and conduit strain (CdS) were calculated using two dimensional speckle tracking echocardiography. Results: LAA EV, Am and Sm and LA PLS, PCS, CdS measurements were found to be significantly lower in the patient group compared to controls. LAA EV measurements showed a strong positive correlation with left atrial volume index (LAVI), LA PLS and LA PCS values, and a negative correlation with left ventricular (LV) diameters, and E/e' value. In the multivariate regression analysis LA PLS and LAVI were found to be independent factors for LAA EV. Conclusion: Our findings suggest that the evaluation of LAA functions with TTE may help determine the increased risk of developing atrial arrhythmias and ischemic stroke in renal transplant candidates. Supporting the current findings with larger studies may change the follow-up and treatment approaches in these patients.