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Renal transplantation is not associated with regression of left ventricular hypertrophy: a magnetic resonance study
Rajan K Patel1, Patrick B Mark, Nicola Johnston
1BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
Insights
Renal transplantation did not significantly reduce left ventricular mass index (LVMI) in end-stage renal failure patients, as measured by cardiac magnetic resonance (CMR). This finding contrasts with previous echocardiography studies, suggesting CMR provides a more accurate assessment of cardiac structure changes post-transplant.
Area of Science:
- Cardiology
- Nephrology
- Medical Imaging
Background:
- End-stage renal failure (ESRF) patients face high cardiovascular disease (CVD) risk.
- Left ventricular hypertrophy (LVH) is a key predictor of adverse CV events and mortality in ESRD.
- Renal transplantation may mitigate CV risk and LVH, but echocardiography may overestimate LV mass.
Purpose of the Study:
- To assess changes in left ventricular mass index (LVMI) using cardiac magnetic resonance (CMR) after renal transplantation.
- To compare LVMI changes in transplanted patients versus those remaining on dialysis.
- To evaluate the effectiveness of renal transplantation in regressing LVH.
Main Methods:
- Fifty patients with ESRD underwent two CMR scans.
- Twenty-five patients received renal transplants between scans.
- CMR measured LVMI, ejection fraction, and ventricular volumes; changes were tracked over time, excluding patients with CV events.
Main Results:
- No significant difference in LVMI change was observed between transplanted patients (2.75%/yr) and those on dialysis (-3.6%/yr).
- Ventricular volumes and ejection fraction also showed no significant changes in either group.
- These findings indicate a lack of significant LVMI regression post-transplantation.
Conclusions:
- Renal transplantation is not associated with significant regression of LVMI as measured by CMR.
- CMR offers a more accurate assessment of cardiac structure compared to echocardiography in ESRD patients.
- Further research may be needed to understand the long-term cardiac benefits of renal transplantation.
Background And Objectives:
Patients with end-stage renal failure (ESRD) have an increased risk of premature cardiovascular (CV) disease. Left ventricular hypertrophy is an independent risk factor for CV events and death in ESRD. Renal transplantation has been associated with reduction in CV risk and echocardiographic regression of left ventricular hypertrophy. However, echocardiography overestimates LV mass in ESRD patients. Cardiac magnetic resonance (CMR) provides more detailed, volume-independent, measures of cardiac structure. Changes in LV mass measured by CMR after renal transplantation were studied.
Design, Setting, Participants, & Measurements:
Fifty patients underwent CMR on two occasions. Twenty-five were transplanted before the second scan. CMR was performed to measure LV mass index (LVMI), ejection fraction, end-diastolic and end-systolic volumes. Changes were expressed as percentage change over time. Patients with CV events between scans (e.g., acute coronary syndrome, myocardial infarction) were excluded. All transplant patients had serum creatinine <150 mumol/L.
Results:
There was no significant change in LVMI between patients who underwent renal transplantation and those who remained on dialysis (transplanted mean, 2.75%/yr, +/- 9.1 versus dialysis, -3.6%/yr +/- 16.7). In addition, there were no significant changes in end-diastolic volume (transplant, 0.1%/yr +/- 19.5 versus not transplanted, -3.4%/yr +/- 31.5), end-systolic volume (transplanted mean, 15.2%/yr +/- 65.2 versus not transplanted, 3.0%/yr +/- 55.5), or ejection fraction (transplant, 2.1%/yr +/- 11.9 versus not transplanted, -0.4%/yr +/- 5.3).
Conclusions:
Renal transplantation is not associated with significant regression of LVMI on CMR compared with patients who remain on the transplant waiting list.
