REMODELING OF THE LEFT ATRIUM IN PATIENTS WITH 4-5 STAGE CHRONIC KIDNEY DISEASE

DOI: https://doi.org/10.29296/25877313-2022-03-03
Issue: 
3
Year: 
2022

I.T. Murkamilov Ph.D. (Med.), Acting Associate Professor of the Department of Faculty Therapy, Nephrologist, Kyrgyz Russian Slavic University; Chairman of the board of Chronic Kidney Disease Specialists (Bishkek, Kyrgyzstan) ORCID:0000-0001-8513-9279 E-mail: murkamilov.i@mail.ru K.A. Aitbaev Dr.Sc. (Med.), Professor, Head of Laboratory of Pathological Physiology; Board Member of Chronic Kidney Disease Specialists Society of Kyrgyzstan; (Bishkek, Kyrgyzstan) ORCID:0000-0003-4973-039X E-mail: kaitbaev@yahoo.com Zh.A. Murkamilova Post-graduate Student, the Department of Therapy N2 of the specialty “General Medicine”, SEI HPE Kyrgyz Russian Slavic University (Bishkek, Kyrgyzstan) ORCID:0000-0002-7653-0433 E-mail: murkamilovazh.t@mail.ru V.V. Fomin Corresponding Member of RAS, Professor, Dr.Sc. (Med.), Head of the Department of Faculty Therapy No. 1, Sklifosovsky Institute; Vice-rector in Clinical Work and Continuous Professional Education, FSAEI HE First Moscow State Medical University named after I.M. Sechenov (Moscow, Russia) ORCID: 0000-0002-2682-4417 E-mail: fomin@mma.ru I.O. Kudaibergenova Dr.Sc. (Med.), Professor, Rector of the Kyrgyz State Medical Academy named after I.K. Akhunbaev (Bishkek, Kyrgyzstan) ORCID: 0000-0003-3007-8127 E-mail: k_i_o2403@mail.ru F.A. Yusupov Dr.Sc. (Med.), Professor, Head of the Department of Neurology, Psychiatry and Medicinal Genetics of Medicinal Faculty, Osh State University; Board Member of Chronic Kidney Disease Specialists Society of Kyrgyzstan; Chief Neurologist of Southern Region of Kyrgyzstan, (Osh, Kyrgyzstan) ORCID: 0000-0003-0632-6653 Е-mail: furcat_y@mail.ru

Purpose of the study. To investigate clinical and functional aspects of the left atrial remodeling in patients with stage 4-5 of the chronic kidney disease (CKD). Materials and methods. A total of 172 patients with CKD stage 4-5 at aged 16‒74 years, were examined. Depending on the anterior-posterior size of the left atrium (LA) in diastole, all examined individuals (n = 172) were divided into two groups: 1st ‒ individuals with CKD and normal size (less than 4.0 cm) of the LA (n = 126), 2nd ‒ patients with CKD and increased anterior-posterior size (more than 4.0 cm) of the LA (n = 46). General physical examination and transthoracic echocardiography with the definition of the LA index in diastole was performed. Results. Statistically significant increase in the end systolic (4.20 ± 0.65 cm vs. 3.55 ± 0.47 cm, p < 0.01) and diastolic dimensions (5.97 ± 0.55 cm vs. 5,38 ± 0,43 cm, p < 0.01), thickness of interventricular septum (1,17 ± 0,16 cm vs 0,99 ± 0,14 cm, p < 0.01) and left ventricular posterior wall (1,13 ± 0.15 cm vs 0.97 ± 0.13 cm, p < 0.01) compared to CKD patients with normal size (less than 4.0 cm) of LA. In patients with left atrial dilatation, significantly higher values of the indexed mass of left ventricular myocardium (267 ± 62 g/m2 vs 198 ± 44 g/m2, p < 0.01) were registered. Eccentric type of the heart structural restructuring was significantly more often detected in the 1st group (87.3% vs 56.5%, p < 0.01) in comparison with the 2nd group. Frequency of the concentric type of left ventricular hypertrophy was significantly higher in the group with left atrial dilatation (43.5% vs 12.7%, p < 0.01) in comparison with the 1st group. In patients with CKD, left atrial dilatation was associated with a significant increase in the anterior ‒ posterior dimension of the right ventricle (2.24 ± 0.47 cm vs 1.83 ± 0.37 cm, p < 0.01) and thickness of its anterior wall (0.41 ± 0.03 cm vs 0.39 ± 0.03 cm, p < 0.01). Patients of the 2nd group had higher body mass index values (25.5 ± 5.14 kg m vs 23.6 ± 3.91 kg/m, p < 0.01), systolic (168 ± 29 mm Hg vs 152 ± 27 mm Hg, p< 0.01) and diastolic (102 ± 20 mm Hg vs 94 ± 15 mm Hg, p < 0.01) arterial pressure, C-reactive protein (84.7% vs 20.6%, p < 0.01). Conclusion. In patients with at predialysis stage of CKD, left atrial remodeling is accompanied by increased levels of C-reactive protein and forming of concentric type of left ventricular hypertrophy.

Keywords: 
left atrial dilatation
left ventricle
stroke
chronic kidney disease

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