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Diastolic left ventricular function after renal transplantation in patients with normal and hypertrophied myocardium
1Center of Internal Medicine, University of Giessen Medical School, Germany.
Insights
Diastolic left ventricular (LV) function in kidney transplant recipients is comparable to non-renal controls. However, LV hypertrophy impacts diastolic filling, showing age-dependency in normal LV mass and mass-dependency in hypertrophied LV patients.
Area of Science:
- Nephrology
- Cardiology
- Echocardiography
Background:
- Diastolic left ventricular (LV) dysfunction is common in end-stage renal disease patients on dialysis.
- Information regarding diastolic LV function post-renal transplantation remains controversial.
- Assessing LV diastolic function is crucial for managing cardiovascular risks in transplant recipients.
Purpose of the Study:
- To analyze Doppler echocardiographic parameters of LV diastolic filling in renal transplant patients.
- To compare diastolic LV function between transplanted patients with normal LV mass and those with LV hypertrophy.
- To compare diastolic LV function in transplanted patients with non-renal controls.
Main Methods:
- Doppler echocardiography was used to assess LV diastolic filling parameters.
- Seventeen transplanted patients with normal LV mass and 24 with LV hypertrophy were studied.
- These groups were compared with 28 normal controls and 11 controls with LV hypertrophy.
Main Results:
- Transplanted patients with LV hypertrophy showed decreased peak early/atrial filling velocity ratios and prolonged isovolumic relaxation periods compared to those with normal LV mass.
- The frequency of abnormal diastolic filling parameters was higher in transplanted patients with LV hypertrophy.
- Diastolic LV function in transplanted patients was comparable to their respective non-renal controls.
Conclusions:
- Diastolic LV filling in renal transplant recipients is comparable to non-renal controls.
- Diastolic function is age-dependent in transplanted patients with normal LV mass.
- Diastolic function is dependent on LV mass in transplanted patients with LV hypertrophy.
Abstract:
While diastolic left ventricular (LV) dysfunction is frequent and associated with cardiovascular complications in end-stage renal disease treated with dialysis, controversial information exists on diastolic LV function after renal transplantation. Therefore, Doppler echocardiographic parameters of LV diastolic filling were analyzed in 17 transplanted patients with normal LV mass (< 150 g/m2; mean: 128 +/- 17 g/m2) and 24 transplanted patients with LV hypertrophy (> 150 g/m2; mean: 197 +/- 36 g/m2) and compared with 28 normal controls without and 11 controls with LV hypertrophy. Mean age (normal vs. increased LV mass: 46 +/- 13 vs. 48 +/- 11 years; p = NS) and transplantation duration (60 +/- 35 vs. 50 +/- 37 months; p = NS) were comparable between renal patients, while systolic blood pressure (136 +/- 12 vs. 149 +/- 14 mmHg; p < 0.02) and serum creatinine (1.55 +/- 0.45 vs. 1.98 +/- 0.76 mg/dl; p < 0.05) were higher in patients with than without LV hypertrophy. In transplanted patients with LV hypertrophy, peak early/atrial filling velocity ratios were decreased (1.17 +/- 0.34 vs. 0.94 +/- 0.34; p < 0.05), mean atrial filling fractions were increased (37 +/- 7% vs. 42 +/- 7%; p < 0.05), and isovolumic relaxation periods were prolonged (86 +/- 23 vs. 106 +/- 26 ms; p < 0.02) compared with transplanted patients with normal LV mass. The frequency of pathologic peak early/atrial filling velocity ratios (12 vs. 42%; p < 0.05), atrial filling fractions (12 vs. 25%; p = NS) and isovolumic relaxation periods (6 vs. 29%; p = NS) was higher in transplanted patients with than without LV hypertrophy. Individual ratios of peak early/atrial filling velocity were inversely correlated with age in transplanted patients with normal LV mass (p < 0.002), and atrial filling fractions were correlated with LV mass index in transplanted patients with LV hypertrophy (p < 0.01). Diastolic LV function was comparable in both groups of transplanted patients with their corresponding non-renal controls. It is concluded that, in transplanted patients, diastolic LV filling is comparable to nonrenal controls; it is age-dependent in patients with normal LV mass and mass-dependent in those with LV hypertrophy.