Changes in left ventricular mass and filling after renal transplantation are related to changes in blood pressure: an echocardiographic and pulsed Doppler study.

Abstract

To examine changes in left ventricular (LV) mass and function (diastolic and systolic) after successful renal allograft transplantation (RT), we prospectively studied 30 patients (19 men, 11 women, aged 37 +/- 13 years) by M-mode, two-dimensional and pulsed Doppler echocardiography at the time of surgery and 10 +/- 1.8 months later. At the time of transplantation all patients had been undergoing dialysis (4 peritoneal dialysis, 26 hemodialysis) for 2.5 +/- 3.2 years. A hematocrit of < or = 30% was present in 26 patients. After RT the mean hematocrit increased from 26 +/- 4 to 40 +/- 7 (p < 0.01), whereas systolic, diastolic and mean blood pressure (BP) remained unchanged. The LV mass index (LVMI) decreased from 201 +/- 56 to 171 +/- 41 g/m2, (p < 0.01); LV diastolic diameter corrected by body surface area (LVDDI) decreased from 298 +/- 38 to 279 +/- 35 (p < 0.01) and the LV end-diastolic volume index (LVEDVI) from 72 +/- 18 to 63 +/- 15 (p < 0.01). There were no changes in LV fractional shortening or LV end systolic wall stress. Peak late transmitral velocity (A wave) decreased from 77 +/- 16 to 68 +/- 12 cm/s (p < 0.01) with no changes in other Doppler-derived indexes of diastolic function. No fistula patency influence on changes in LV mass and function was found. After RT, BP decreased in 21 patients from 150 +/- 20 to 132 +/- 15 (p < 0.001; group I) and increased in 9 patients from 130 +/- 14 to 153 +/- 16 (p < 0.05, group II). Patients in group I suffered a reduction in LVMI (p < 0.001), LV end-diastolic diameter (p < 0.05), LVDDI (p < 0.001); LV end-diastolic volume (p < 0.05); LVEDVI (p < 0.01); cardiac index (p < 0.05), and peak late transmitral velocity (p < 0.01), but no changes in group-II patients were observed. We concluded that BP is a major determining factor with regard to changes in LV hypertrophy and function following RT. LV mass and volumes can be expected to decrease after RT in patients with BP reduction.