Cardiovascular disease remains a leading cause of morbidity after kidney transplantation (KT). While left atrial (LA) volume and strain parameters have prognostic value in several cardiac conditions, their role in predicting major adverse cardiovascular events (MACE) in KT recipients has not been explored. This retrospective analysis published in the Journal of the American Heart Association assessed the association between baseline LA parameters and major adverse cardiovascular events (MACE) after KT.

Records of adult KT recipients from 2015 to 2024 were reviewed. Baseline echocardiograms obtained during KT evaluation were analyzed to measure LA volumetrics and strain. The primary endpoint was MACE, defined as cardiovascular death, nonfatal myocardial infarction, stroke, major arrhythmias, or heart failure hospitalization. Logistic regression, Kaplan–Meier survival analysis, and Cox proportional hazards models were used to assess associations.

Among 518 KT recipients, 377 patients in sinus rhythm with adequate echocardiographic quality were included (56.7% male; mean age 53.7 ± 13.1 years). Over a median follow-up of 5.3 ± 2.3 years, 82 patients experienced MACE. Kaplan-Meier analysis revealed significantly lower MACE-free survival in patients with abnormal LA strain. In multivariable Cox analysis, lower LA strain conduit (LAScd; hazard ratio [HR] 0.94; 95% confidence interval [CI] 0.89–0.98; p=0.003) and lower LA strain reservoir (LASr; HR 0.97; 95% CI 0.94–0.995; p=0.02) were independently associated with MACE.

Reduced LA strain parameters, particularly LAScd and LASr, were independently associated with MACE after KT. LA strain may have a role in risk stratification in this population.