Abstract
Echocardiography is commonly performed as a screening test to evaluate perioperative risks before kidney transplantation. However, only limited data are available on echocardiographic parameters of left ventricular diastolic dysfunction (LVDD) and left atrial enlargement (LAE) on acute coronary syndrome and mortality in kidney transplant recipients. We reviewed 2779 adult recipients who underwent pretransplant echocardiography from 1997 to 2012. We divided the patients into two and four groups by two categories: LVDD grades 0–1 vs. 2–3, and left atrial size quartile groups. During a mean follow-up of 4.5 years, acute coronary syndrome occurred in 89 (3.2%) patients. The recipients with LVDD grades 2–3 (P = 0.005 for non-fatal, P = 0.02 for fatal/non-fatal) and LAE (P = 0.001 for non-fatal, P = 0.03 for fatal/non-fatal) had a higher incidence of acute coronary syndrome after kidney transplantation. All-cause mortality did not differ significantly between the groups. In a multivariate analysis, LVDD of grades 2–3 (hazard ratio 2.98, 95% confidence interval 1.535–5.787; P = 0.001), and LAE (hazard ratio 1.052, 95% confidence interval 1.006–1.101; P = 0.03) were independently associated with non-fatal acute coronary syndrome. In patients who are kidney transplant candidates, pretransplant LVDD and LAE were independently associated with a higher incidence of acute coronary syndrome after kidney transplantation.
Highlights
Kidney transplant (KT) recipients have demonstrated improved survival compared with patients undergoing dialysis, cardiovascular (CV) mortality is the leading cause of death following kidney transplant (KT), accounting for 40–55% of all deaths [1, 2]
An increase in left atrial volume index (LAVI) and E wave over tissue-Doppler imaging of the E wave (E/E’) ratio is associated with elevated left ventricular (LV) filling pressures and significant diastolic dysfunction [10]
In KT recipients, there have been observed a significant reduction in left ventricular diastolic dysfunction (LVDD) rates after KT, and it may be caused by resolved occult volume overload [11, 12]
Summary
Kidney transplant (KT) recipients have demonstrated improved survival compared with patients undergoing dialysis, cardiovascular (CV) mortality is the leading cause of death following KT, accounting for 40–55% of all deaths [1, 2]. An increase in left atrial volume index (LAVI) and E wave over tissue-Doppler imaging of the E wave (E/E’) ratio is associated with elevated left ventricular (LV) filling pressures and significant diastolic dysfunction [10]. In KT recipients, there have been observed a significant reduction in left ventricular diastolic dysfunction (LVDD) rates after KT, and it may be caused by resolved occult volume overload [11, 12]. Despite the potential benefits of KT on cardiac function, one study suggested that pre-KT left ventricular hypertrophy (LVH), ventricular dilatation, and systolic dysfunction were associated with higher allcause mortality and CV mortality after KT [7]. Age, LV end-systolic diameter, maximal wall thickness, and mitral annular calcification were proposed as independent predictors of mortality after KT [8]
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