E867 JACC March 12, 2013 Volume 61, Issue 10 Imaging FREQUENCY AND PROGNOSTIC IMPLICATIONS OF ELEVATED LEFT ATRIAL PRESSURE IN THE PRESENCE OF NORMAL RIGHT ATRIAL PRESSURE IN HEMODIALYSIS PATIENTS: RESULTS FROM A PROSPECTIVE COHORT OF 442 PATIENTS Poster Contributions 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 Authors: Waqas Aftab, Padmini Varadarajan, Ali Motabar, Juliana Gazallo, Ramdas Pai, Loma Linda University Medical Center, Loma Linda, CA, USA Background: 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. Methods: 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. Results: 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) Conclusion: 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.

FREQUENCY AND PROGNOSTIC IMPLICATIONS OF ELEVATED LEFT ATRIAL PRESSURE IN THE PRESENCE OF NORMAL RIGHT ATRIAL PRESSURE IN HEMODIALYSIS PATIENTS: RESULTS FROM A PROSPECTIVE COHORT OF

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Page 1: FREQUENCY AND PROGNOSTIC IMPLICATIONS OF ELEVATED LEFT ATRIAL PRESSURE IN THE PRESENCE OF NORMAL RIGHT ATRIAL PRESSURE IN HEMODIALYSIS PATIENTS: RESULTS FROM A PROSPECTIVE COHORT OF

E867JACC March 12, 2013Volume 61, Issue 10

Imaging

freQuency and prognosTic implicaTions of elevaTed lefT aTrial pressure in The presence of normal righT aTrial pressure in hemodialysis paTienTs: resulTs from a prospecTive cohorT of 442 paTienTs

Poster ContributionsPoster Sessions, Expo NorthSaturday, March 09, 2013, 10:00 a.m.-10:45 a.m.

Session Title: Imaging: LV Diastolic FunctionAbstract Category: 18. Imaging: EchoPresentation Number: 1143-358

Authors: Waqas Aftab, Padmini Varadarajan, Ali Motabar, Juliana Gazallo, Ramdas Pai, Loma Linda University Medical Center, Loma Linda, CA, USA

Background: 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.

methods: 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.

results: 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)

conclusion: 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.