Paoletti Ernesto, Zoccali Carmine
Nephrology, Dialysis, and Transplantation, University of Genoa, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy.
Renal and Transplantation Unit and CNR-IBIM, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Ospedali Riuniti, Reggio Calabria, Italy.
Nephrol Dial Transplant. 2014 Oct;29(10):1847-53. doi: 10.1093/ndt/gft482. Epub 2013 Nov 27.
Altered left ventricular (LV) mass and function are classical hallmarks of cardiomyopathy in chronic kidney disease (CKD). The left atrium (LA), a heart chamber exquisitely sensitive to volume overload and diastolic function, is an independent predictor of death and adverse cardiovascular (CV) events in high-risk patients such as those with hypertension and/or with heart failure. In this review we focus on the relationship of LA size with LV diastolic function, and the association between LA enlargement and CV and renal outcomes in patients with CKD, including patients with end-stage renal disease. Increased LA size emerges as a powerful predictor of mortality and major adverse CV events in both end-stage and early CKD, and some studies also show a close association between enlarged LA and renal disease progression. Secondary analyses of clinical trials suggest that the LA has the potential to be elected as a surrogate end point in CKD patients but the issue remains to be tested in specifically designed clinical studies.
左心室（LV）质量和功能改变是慢性肾脏病（CKD）中心肌病的典型特征。左心房（LA）是一个对容量超负荷和舒张功能极为敏感的心脏腔室，在高血压和/或心力衰竭等高危患者中，它是死亡和不良心血管（CV）事件的独立预测因子。在本综述中，我们重点关注左心房大小与左心室舒张功能的关系，以及慢性肾脏病患者（包括终末期肾病患者）左心房扩大与心血管和肾脏结局之间的关联。在终末期和早期慢性肾脏病中，左心房增大均成为死亡率和主要不良心血管事件的有力预测因子，一些研究还表明左心房扩大与肾脏疾病进展密切相关。临床试验的二次分析表明，左心房有潜力被选为慢性肾脏病患者的替代终点，但这一问题仍有待在专门设计的临床研究中进行验证。
