Impact of renal function on left atrial function and left atrioventricular interaction in hypertension with preserved ejection fraction using cardiac magnetic resonance

Abstract Objectives To assess the impact of renal function on left atrial (LA) function and left atrioventricular coupling evaluated by cardiac magnetic resonance (CMR) in patients with hypertension and preserved ejection fraction and to further explore the association between renal impairment severity and LA strain. Methods 146 hypertensive patients without chronic kidney disease (CKD), 101 hypertensive patients with CKD and eGFR ≥ 60 mL/min/1.73 m2 and 28 hypertensive patients with CKD and eGFR < 60 mL/min/1.73 m2 were consecutively enrolled in this retrospective study from October 2018 to March 2023. The CMR-derived parameters were compared among the three groups by analysis of covariance. Multivariable linear regression was performed to assess the independent association of renal impairment severity with LA phasic strain. Results After adjusting for clinical characteristics, there was a significant gradual decrease in LV global longitudinal strain, LA reservoir function from hypertension without CKD to those with CKD and different CKD stages, and left atrioventricular coupling index was significantly higher in hypertensive patients with eGFR < 60 mL/min/1.73 m2 compared to those without CKD and with eGFR ≥ 60 mL/min/1.73 m2 (all P < 0.05). Multivariable linear regression analysis with adjustment of clinical parameters and imaging variables showed that more severe renal impairment and worsening eGFR levels were independently associated with decreased εs. Conclusions Renal insufficiency could exacerbate LA dysfunction and left atrioventricular coupling impairment in hypertensive patients. Advances in knowledge CMR can provide imaging evidence for early evaluation of cardiac injury in patients with hypertension and renal dysfunction.