Left atrial strain predicts cardiovascular mortality in end-stage kidney disease: results from a 10-year longitudinal cohort

Abstract Background Individuals with end-stage kidney disease (ESKD) face a significantly elevated risk of adverse cardiovascular events—a risk that is often underestimated by conventional risk stratification models. Among these patients, those undergoing maintenance hemodialysis (HD) therapy exhibit particularly high rates of cardiovascular mortality. This study aimed to identify clinical and echocardiographic predictors of adverse cardiovascular outcomes in patients with ESKD under HD therapy. Methods The study enrolled patients aged between 18 and 85 years who had been receiving HD treatment for a minimum of six months. A total of 80 patients without a prior history of cardiac disease were prospectively included. All participants underwent transthoracic echocardiographic evaluation, including assessment of left ventricular (LV) and left atrial (LA) strain parameters. Participants were followed for a minimum of 10 years to monitor all-cause mortality and major adverse cardiovascular events (MACE). Results The primary composite outcome occurred in 58 patients, with 34 deaths recorded during the follow-up period. Older age, duration of hemodialysis treatment, increased LV mass, reduced LV global longitudinal strain (LVGLS), and diminished LA reservoir strain (LASr) were identified as significant predictors of mortality and MACE (all P < .05). In multivariable regression analysis, only LASr and LVGLS remained as independent predictors of the outcomes. Receiver operating characteristic curve analysis demonstrated that LASr was the most robust predictor of adverse events, with an area under the curve (AUC) of 0.76 (Figure 1). Conclusions LASr is an independent and powerful predictor of mortality and MACEin patients with end-stage kidney disease undergoing HD.