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Cardiac Loading using Passive Left Atrial Pressurization and Passive Afterload for Graft Assessment
Published on: August 2, 2024
Subclinical left ventricular echocardiographic abnormalities 1 year after kidney transplantation are associated with
1Department of Nephrology, University Medical Center Ljubljana, Ljubljana, Slovenia. miha.arnol@mf.uni-lj.si
Insights
In kidney transplant recipients, impaired kidney function at one year is linked to increased left ventricular mass and higher rates of cardiac events. Left ventricular hypertrophy significantly elevates the risk of future cardiovascular events.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Medicine
Background:
- Cardiovascular events (CVE) are the primary cause of mortality in kidney transplant recipients.
- Increased left ventricular mass (LVM) is a known risk factor for CVE.
- The relationship between graft function and cardiac remodeling in these patients requires further investigation.
Purpose of the Study:
- To examine the association between left ventricular mass (LVM) and impaired kidney graft function (eGFR) at one year post-transplant.
- To investigate the link between LVM and the incidence of future cardiovascular events (CVE) beyond one year.
- To determine if left ventricular hypertrophy (LVH) predicts future CVE in kidney transplant recipients.
Main Methods:
- Prospective cohort study of 68 non-diabetic kidney transplant recipients.
- Transthoracic echocardiography at one year post-transplantation to assess LVM and LVH.
- Estimated glomerular filtration rate (eGFR) calculated using the MDRD formula.
- Cox proportional hazards analysis used to evaluate the risk of future CVE.
Main Results:
- Lower eGFR (<60 mL/min/1.73 m²) at one year was associated with increased LVM and higher incidence of LVH (86% vs 50%).
- Patients with LVH at one year had a significantly higher incidence of cardiac CVE during follow-up (36.4% vs 8.3%).
- LVH was independently associated with an increased risk of future CVE (HR, 4.69; P = .037).
Conclusions:
- Impaired kidney graft function at one year post-transplantation is associated with greater left ventricular mass and a higher prevalence of left ventricular hypertrophy.
- Left ventricular hypertrophy in kidney transplant recipients is a significant predictor of future cardiovascular events.
- Monitoring cardiac structure and function is crucial in kidney transplant recipients, particularly those with declining graft function.
Abstract:
Cardiovascular events (CVE) are the leading cause of mortality in kidney transplant recipients. Increased left ventricular mass (LVM) is a risk factor for CVE. This study investigated the associations of LVM with impaired kidney graft function expressed as lower glomerular filtration rate (GFR) at 1 year after transplantation and future CVE beyond 1 year. The prospective study cohort included 68 nondiabetic recipients of a kidney transplant between January 2004 and December 2005 who underwent a transthoracic echocardiographic investigation at 1 year after transplantation. LVM and left ventricular hypertrophy (LVH) were assessed using 2-dimensional M-mode echocardiography. GFR was estimated (eGFR) by the 4-variable Modification of Diet in Renal Disease formula. Cox proportional hazards analysis was used to estimate cardiac CVE (angina pectoris, acute myocardial infarct, coronary angioplasty or bypass surgery, or sudden cardiac death) hazard ratios (HRs) for patients with LVH versus control subjects with no LVH at 1 year after transplantation. All patients had normal systolic function (ejection fraction >50%) with no symptoms or signs of heart failure. LVH was present in 44 patients (65%). LVM and incidence of LVH were increased in 28 patients with eGFR <60 mL/min/1.73 m(2) compared with 40 patients with eGFR ≥60 mL/min/1.73 m(2) (248 ± 61 g and 86% vs 210 ± 46 g and 50%, respectively; P < .01). After a median follow-up of 4.5 years, there were 18 (26.5%) cardiac CVE. The incidence of CVE was higher in patients with LVH than in patients with no LVH at 1 year after transplantation (36.4% vs 8.3%; P = .020). In adjusted analyses, LVH was associated with an increased risk for future CVE (HR, 4.69; 95% confidence interval, 1.02-21.5; P = .037). In kidney transplant recipients, a lower eGFR at 1 year after transplantation was associated with greater LVM and higher incidence of LVH. Presence of LVH was associated with an increased risk for future CVE.
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