Shizuku Junichi, Yamashita Tetsuri, Ohba Takashi, Kabaya Takashi, Nitta Kosaku
Department of Medicine, Kidney Center, Tokyo Women's Medical University, Japan.
Intern Med. 2012;51(12):1479-85. doi: 10.2169/internalmedicine.51.7284. Epub 2012 Jun 15.
An enlarged left atrium (LA) has recently been identified as a risk factor for adverse cardiovascular outcomes in various pathologic conditions. However, few studies have evaluated its prognostic value in hemodialysis (HD) patients.
We conducted an observational study to investigate whether an enlarged LA predicted all-cause mortality in 174 HD patients. Patients were stratified into two groups based on the LA volume index (LAVI) value of 32 mL/m.
An increased left atrial volume index (LAVI >32 mL/m(2)) was present in 28 (16.1%) of the HD patients. During the follow-up period (50.1 ± 22.4 months), 77 patients (44.3%) died. A Kaplan-Meier analysis revealed that the 7-year survival rate was significantly lower in the group whose LAVI was >32 mL/m(2) than in the group whose LAVI was ≤ 32 mL/m(2) (p=0.0033). Multivariate analyses adjusted for echocardiographic parameters and clinical and laboratory data showed that increased LAVI was an independent predictor of all-cause mortality (hazard ratio 1.030, 95% confidence interval 1.004-1.056, p=0.0260). Moreover, increased LAVI had a higher predictive value for all-cause mortality (area under the receiver operating characteristic curve=0.612, p=0.0059) among the measured echocardiographic parameters.
The results of the present study suggested that measurement of LAVI may be helpful in the risk stratification of HD patients and in providing therapeutic direction for their management.
最近已确定左心房（LA）增大是各种病理状况下不良心血管结局的危险因素。然而，很少有研究评估其在血液透析（HD）患者中的预后价值。
我们进行了一项观察性研究，以调查LA增大是否可预测174例HD患者的全因死亡率。根据左心房容积指数（LAVI）值32 mL/m²将患者分为两组。
28例（16.1%）HD患者存在左心房容积指数增加（LAVI>32 mL/m²）。在随访期（50.1±22.4个月）内，77例患者（44.3%）死亡。Kaplan-Meier分析显示，LAVI>32 mL/m²组的7年生存率显著低于LAVI≤32 mL/m²组（p=0.0033）。经超声心动图参数、临床和实验室数据校正的多变量分析表明，LAVI增加是全因死亡率的独立预测因素（风险比1.030，95%置信区间1.004-1.056，p=0.0260）。此外，在测量的超声心动图参数中，LAVI增加对全因死亡率具有更高的预测价值（受试者工作特征曲线下面积=0.612，p=0.0059）。
本研究结果表明，测量LAVI可能有助于HD患者的风险分层，并为其管理提供治疗方向。
