Abstract
BackgroundCardiovascular disease is a significant cause of morbidity and mortality in patients with end-stage renal disease (ESRD) and kidney transplant (KT) patients. Compared with left ventricular (LV) ejection fraction (LVEF), LV strain has emerged as an important marker of LV function as it is less load dependent. We sought to evaluate changes in LV strain using cardiovascular magnetic resonance imaging (CMR) in ESRD patients who received KT, to determine whether KT may improve LV function.MethodsWe conducted a prospective multi-centre longitudinal study of 79 ESRD patients (40 on dialysis, 39 underwent KT). CMR was performed at baseline and at 12 months after KT.ResultsAmong 79 participants (mean age 55 years; 30% women), KT patients had significant improvement in global circumferential strain (GCS) (p = 0.007) and global radial strain (GRS) (p = 0.003), but a decline in global longitudinal strain (GLS) over 12 months (p = 0.026), while no significant change in any LV strain was observed in the ongoing dialysis group. For KT patients, the improvement in LV strain paralleled improvement in LVEF (57.4 ± 6.4% at baseline, 60.6% ± 6.9% at 12 months; p = 0.001). For entire cohort, over 12 months, change in LVEF was significantly correlated with change in GCS (Spearman’s r = − 0.42, p < 0.001), GRS (Spearman’s r = 0.64, p < 0.001), and GLS (Spearman’s r = − 0.34, p = 0.002). Improvements in GCS and GRS over 12 months were significantly correlated with reductions in LV end-diastolic volume index and LV end-systolic volume index (all p < 0.05), but not with change in blood pressure (all p > 0.10).ConclusionsCompared with continuation of dialysis, KT was associated with significant improvements in LV strain metrics of GCS and GRS after 12 months, which did not correlate with blood pressure change. This supports the notion that KT has favorable effects on LV function beyond volume and blood pessure control. Larger studies with longer follow-up are needed to confirm these findings.
Highlights
Chronic kidney disease (CKD) is well-known risk factor for adverse cardiovascular events [1]
Given that left ventricular (LV) strain is less load dependent, its use to evaluate changes in LV function is attractive in end-stage renal disease (ESRD) patients who are subject to large fluctuations in preload and afterload [13]
We consented 89 patients of whom 79 (22 peritoneal dialysis and 57 hemodialysis; 40 patients continued on dialysis and 39 patients received kidney transplant (KT)) had complete cardiovascular magnetic resonance imaging (CMR)-derived measurements at baseline and at 12 months (Table 1)
Summary
Chronic kidney disease (CKD) is well-known risk factor for adverse cardiovascular events [1]. While left ventricular (LV) hypertrophy (LVH) has been identified as a marker of poor prognosis and adverse outcomes in dialysis patients, a large proportion of ESRD patients have preserved LV ejection fraction (LVEF) [5,6,7]. Measurable reduction in LVEF represents late LV dysfunction, and may only identify CKD patients with well-established cardiovascular disease [8]. Structural changes such as LV mass (LVM) and volume have been associated with subsequent reduction in LVEF, LV myocardial deformation (strain) is likely a more sensitive measure of early subclinical myocardial dysfunction as it directly reflects the motion of myocardial fibers. We sought to evaluate changes in LV strain using cardiovascular magnetic resonance imaging (CMR) in ESRD patients who received KT, to determine whether KT may improve LV function
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