Utility of C2 Monitoring in Prediction of Diastolic Dysfunction in Renal Transplant Recipients

Abstract

Background A number of experimental studies have suggested that cyclosporine (CsA) toxicity induces cardiac modifications which may cause diastolic dysfunction over the course of time. Doppler echocardiography with tissue Doppler imaging (TDI) could consistently detect diastolic dysfunction. The purpose of this study was to assess diastolic dysfunction using C2 monitoring of CsA exposure in stable renal transplant patients. Patients and Methods Seventy-eight kidney recipients including 42 men and 36 women of overall mean age of 52 ± 9 years were obtained in 47 living and in 31 cases from cadaveric donations over 12 or more months after transplantation using cases from CsA, mycophenolate mofetil, and steroid. C2 levels were measured by an enzyme multi-immune assay technique. The patients underwent conventional and Doppler echocardiography with TDI. Results The patients were divided into 2 groups according to C2 levels less than 500 μg/L (group 1, n = 40) versus greater than 500 μg/L (group 2, n = 38). The demographic parameters, serum creatinine and lipid levels, systolic and diastolic blood pressures, number and type of antihypertensive medications, and conventional echocardiographic parameters did not differ significantly between the groups. However, group 1 patients showed significantly higher isovolumic relaxation time (109 ± 27 vs 86 ± 14 ms), early diastolic deceleration time (189 ± 52 vs 137 ± 59 ms), and lower values of E velocity (56 ± 32 vs 92 ± 27 cm/s) and E/A ratios (0.81 ± 0.23 vs 1.15 ± 0.46) than group 2. TDI studies revealed significantly lower E′/A′ (0.76 ± 0.25 vs 1.09 ± 0.32, P < .05) in group 1 versus group 2. Conclusion The data suggested that the higher C2 levels may induce diastolic dysfunction in the hearts of kidney recipients without impairment of contractile performance.