Left Atrial Strain Value Versus Tissue Doppler Echocardiography and the Left Atrium Volume Index in The Evaluation of Left Ventricular Diastolic Function in Patients with Chronic Kidney Disease

Background: The left atrium's (LA) filling and discharge is quantified by LA strain. LA strain has been established as a metric for diastolic dysfunction in heart failure with preserved and reduced ejection fraction (HFpEF and HFrEF, respectively). We sought to address the role of LA strain value versus tissue Doppler echocardiography and the left atrial volume index (LAVI) in the left ventricular (LV) diastolic function evaluation in chronic kidney disease (CKD) patients. Method: A prospective cross section study was conducted on 220 outpatients of CKD that fulfilled the inclusion criteria and referred to cardiology clinic at Tanta University for routine echocardiographic assessment during a period of six months (April to September 2024). Patients were divided into subgroups based on their estimated Glomerular Filtration Rate (eGFR) into 5 groups; Group 1: GFR 90-120 mL/min/1.73 m2, Group2: GFR 60-90 mL/min/1.73 m2, group 3: GFR 30-60 mL/min/1.73 m2, group 4: GFR 15-29 mL/min/1.73 m2, group 5: GFR <15 mL/min/1.73 m2. Echocardiographic parameters including systolic and diastolic volumes of left ventricle, LA strain, LAVI, ejection fraction (EF), and E/e ratio were measured in all participants. Results: LA strain conduit and reservoir strain can significantly diagnose LV Diastolic Function in CKD Patients (P <0.001 and AUC=0.819 and 0.869 respectively) at cutoff ≤36 and >-23, with 86% and 95.5% sensitivity, 65% and 60% specificity, 96.1% and 96% PPV and 31.7% and 57.1% NPV respectively. AUC=0.926 was observed with LAVI among grade 1 vs grade 0 (0.9 is considered excellent in diagnosing patients with and without the disease). While other markers among the grades of the diastolic function had AUC of 0.5-0.6, which suggests no discrimination in diagnosing the disease. Conclusions: LA conduit strain and reservoir strain are independent markers that is superior and more sensitive approach than LAVI and tissue Doppler echocardiography for evaluating LV diastolic dysfunction in patients with CKD even in the early stages.