Abstract
Introduction: Cardiac dysfunction is a major cause of morbidity and mortality in patients with end-stage renal disease (ESRD). Previous studies have shown that kidney transplantation can reverse some of the gross changes in the myocardial structure such as left ventricular ejection fraction (LVEF) and volumes. Whether kidney transplantation can reverse the subtle and early myocardial changes in ESRD patients who do not suffer from gross alternations in myocardial function is not yet studied. The aim of this study was to answer this question. Methods: We followed 25 patients with ESRD at baseline that all of them had a kidney transplant and were reassessed 1 month after the transplantation. Conventional and speckle tracking echocardiography (STE)was done at baseline and 1 month after kidney transplantation in patients. Results: LV hypertrophy was the most prevalent finding at baseline (58%), followed by diastolic dysfunction (53%). Kidney transplantation significantly improved the ejection fraction (EF) (treatment effect = 4.23 ± 2.06%; P = 0.046) and apical 4-chamber strain (treatment effect = -0.89 ± 0.37%; P = 0.021) in the patients. It also reduced the LV mass index (treatment effect = -73.82 ± 11.6; P < 0.001) and relative wall thickness (treatment effect = -0.056±0.023; P = 0.021). Other variables including global longitudinal strain and diastolic dysfunction were not improved significantly. Conclusion: STE may show early improvements in myocardial function 1 month after renal transplantation.
Highlights
Cardiac dysfunction is a major cause of morbidity and mortality in patients with end-stage renal disease (ESRD)
Parameters in echocardiography examination included (1) LV morphology: Left ventricular end diastolic diameter (LVEDD), LV end systolic diameter (LVESD), LV end-diastolic volume (LVEDV), LV end systolic volume (LVESV), Posterior wall thickness (PWT), Interventricular septal thickness (IVS), LV mass (LVM), LV mass index corrected by body surface area (LVMI), and Relative wall thickness (RWT). (2) LV systolic function: ejection fraction (EF) by Simpson method, Fractional shortening (FS). (3) Diastolic function: Early mitral inflow diastolic velocity (E), atrial contraction mitral inflow diastolic velocity (A), E/A ratio, tissue Doppler velocity at Interventricular septum (e′), E/e′ ratio
Causes of ESRD were hypertensive nephropathy, diabetic nephropathy, autosomal dominant polycystic kidney disease (ADPKD), Alport syndrome, nephrotic syndrome, chronic glomerulonephritis and idiopathic or unknown causes were most prevalent in patients (40%)
Summary
Cardiac dysfunction is a major cause of morbidity and mortality in patients with end-stage renal disease (ESRD). Left ventricular (LV) systolic and diastolic dysfunction had a prevalence of 38.4% in ESRD patients most of whom (82%) were asymptomatic.[2] symptomatic heart failure in ESRD patients (ejection fraction [EF] less than 40%) is shown to be associated with lower survival.[3] The most prevalent echocardiographic finding in ESRD patients is LV hypertrophy (56.9%) and most of these patients had a normal systolic function.[4,5] Prevalence of valvular regurgitation like mitral regurgitation (MR) and aortic regurgitation (AR) was 2.7% and 1.3%, respectively.[4] EF and LV dilation were the strongest predictors of survival in these patients.[3,4,5] Echocardiography is a practical available tool for detection of these gross cardiac changes before and after renal transplantation.[4] In addition, new echocardiographic techniques are available that can detect subtle cardiac alteration, and may help implement preventive therapies to protect the heart from gross alterations. Tissue Doppler imaging is a method for accurate estimation of myocardial
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
