Abstract 17298: Association of Left Atrial Size and Incident Heart Failure and All-cause Death: The Chronic Renal Insufficiency Cohort (CRIC) Study

Abstract

Introduction: Chronic kidney disease (CKD) increases the risk for adverse cardiovascular events including heart failure (HF) and death. Left atrial size is an easily quantified metric that provides prognostic information in non-CKD populations. Hypothesis: We hypothesized that left atrial size would be an independent risk marker for incident HF and death in individuals with CKD. Methods: The Chronic Renal Insufficiency Cohort (CRIC) is a large, multicenter, multiracial cohort study established to understand the progression of cardiovascular and renal disease among individuals with CKD. We evaluated echocardiograms among participants without a history of heart failure. The left atrial area was measured in the apical 4-chamber view and indexed to body surface area (LAAI). Cox proportional hazards models were constructed to assess the risk between left atrial size and incident HF and death. Results: Among the 2960 CKD participants without known heart failure, higher tertiles of LAAI were associated with older age, Hispanic ethnicity, a history of stroke, myocardial infarction, atrial fibrillation, higher systolic blood pressure, hypertension, diabetes, and lower eGFR (P<0.005 for all). The median left ventricular ejection fraction was 55% across LAAI tertiles. Over a median [IQR] follow-up of 6.6 [5.7-7.6] years, 344 participants developed HF and 472 died. An increase in LAAI was a strong risk marker for the development of heart failure after multivariable adjustment (Table 1). LAAI was modestly associated with all-cause death after controlling for demographics and clinical variables; however, additional adjustment for echocardiographic variables and cardiac biomarkers rendered the association non-significant. There was no significant interaction between LAAI and sex or race for either outcome. Conclusion: Among adults with CKD, LAAI is a stronger marker of risk for incident HF than death.