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Elevated right atrial pressure (RAP) is common in ESRD patients. Elevated JVP is often used to adjust dialysis regimens and volume status in these patients. Little is known about frequency and clinical implications of isolated left atrial pressure (LAP) elevation in the presence of normal RAP.
We prospectively followed 442 patients who underwent pre-renal transplant cardiac risk assessment at our dedicated cardiology clinic. RAP was estimated clinically. Same day echocardiogram was performed to evaluate IVC size and RAP. High LAP was diagnosed when mitral E to E prime ratio was > =15. Survival analysis was performed as function of RAP and LAP.
Patient characteristics: age 57+11 years, men 64%, diabetes in 68%, CAD 24%, EF 61+11%. 15% of patients had high RAP by examination and 30% by echocardiography. Elevated LAP with normal RAP was found in 31% of the patients, but all patients with high RAP had high LAP. On Cox proportional hazard analysis isolated high LAP was predictive of poor survival (HR 2.39, 95% CI 1.07-5.32, P=0.03) adjusted for age, gender, smoking, diabetes, EF and medical therapy. As shown in the figure, there was a graded increase in mortality with added elevation of RAP (P=0.004)
1) High LAP with normal RAP is common in ESRD patients and is independently associated with higher mortality. 2) High RAP has incremental mortality effect. 3) Achievement of euvolemic status not only on the basis of RAP, but LAP estimate as well is prudent in this high risk population.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Imaging: LV Diastolic Function
Abstract Category: 18. Imaging: Echo
Presentation Number: 1143-358
- 2013 American College of Cardiology Foundation