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Updated: Nov 5, 2025
Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
Published on: October 28, 2020
Changes in left ventricular structure and function associated with renal transplantation: a systematic review and
Luke C Pickup1, Jonathan P Law1, Ashwin Radhakrishnan1
1Birmingham Cardio-Renal Group, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
Insights
Renal transplantation does not reverse cardiac changes in uraemic cardiomyopathy. Limited and methodologically weak evidence suggests no significant differences in key cardiac measures post-transplant. Further research is needed.
Area of Science:
- Nephrology
- Cardiology
- Translational Medicine
Background:
- Uraemic cardiomyopathy is a significant complication in patients with chronic kidney disease.
- Cardiac structural and functional changes are common in uraemia.
- The potential for reversal of these cardiac changes following renal transplantation remains unclear.
Purpose of the Study:
- To systematically review and meta-analyze existing evidence on the reversibility of uraemic cardiomyopathy after successful renal transplantation.
- To assess the impact of renal transplantation on cardiac structure and function in patients with uraemic cardiomyopathy.
Main Methods:
- A comprehensive literature search was conducted across multiple databases (MEDLINE, Embase, OpenGrey, Cochrane Library) from 1950 to March 2020.
- Studies utilizing imaging modalities (echocardiography, cardiac MRI) before and after renal transplantation were included.
- Meta-analysis was employed to synthesize data, with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system used for evidence quality assessment.
Main Results:
- Twenty-six studies met the inclusion criteria; 23 used echocardiography and 3 used cardiac MRI.
- Methodological quality of the included studies was generally poor.
- Meta-analysis revealed no significant differences in left ventricular mass index (SMD -0.07, 95% CI -0.41 to 0.26), left ventricular ejection fraction (MD 0.39%, 95% CI -4.09% to 4.87%), or left ventricular end-diastolic volume (SMD -0.24, 95% CI -0.94 to 0.45) post-transplantation.
- Analysis of diastolic dysfunction changes was precluded by inconsistent reporting.
Conclusions:
- Current evidence does not support the reversibility of uraemic cardiomyopathy following renal transplantation.
- The findings are limited by significant methodological weaknesses in the available studies.
- Further high-quality research is warranted to definitively assess the impact of renal transplantation on uraemic cardiomyopathy.
Aims:
This study aimed to examine if the cardiac changes associated with uraemic cardiomyopathy are reversed by renal transplantation.
Methods And Results:
MEDLINE, Embase, OpenGrey, and the Cochrane Library databases were searched from 1950 to March 2020. The primary outcome measure was left ventricular mass index. Secondary outcome measures included left ventricular dimensions and measures of diastolic and systolic function. Studies were included if they used any imaging modality both before and after successful renal transplantation. Data were analysed through meta-analysis approaches. Weight of evidence was assessed through the Grading of Recommendations Assessment, Development and Evaluation system. Twenty-three studies used echocardiography, and three used cardiac magnetic resonance imaging as their imaging modality. The methodological quality of the evidence was generally poor. Four studies followed up control groups, two using cardiac magnetic resonance imaging and two using echocardiography. Meta-analysis of these studies indicated that there was no difference in left ventricular mass index between groups following transplantation {standardized mean difference -0.07 [95% confidence interval (CI) -0.41 to 0.26]; P = 0.67}. There was also no difference observed in left ventricular ejection fraction [mean difference 0.39% (95% CI -4.09% to 4.87%); P = 0.86] or left ventricular end-diastolic volume [standardized mean difference -0.24 (95% CI -0.94 to 0.45); P = 0.49]. Inconsistent reporting of changes in diastolic dysfunction did not allow for any meaningful analysis or interpretation.
Conclusions:
The evidence does not support the notion that uraemic cardiomyopathy is reversible by renal transplantation. However, the evidence is limited by methodological weaknesses, which should be considered when interpreting these findings.
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