Changes in Cardiac Structure and Function After Kidney Transplantation: A New Perspective Based on Strain Imaging

Area of Science:

• Cardiology
• Nephrology
• Cardiac Imaging

Background:

• End-stage renal disease (ESRD) is associated with significant cardiovascular complications.
• Left ventricular (LV) global longitudinal strain (GLS) is a sensitive marker of myocardial function.
• The impact of kidney transplantation (KT) on LV GLS in ESRD patients is not fully understood.

Purpose of the Study:

• To investigate LV global longitudinal strain (GLS) in patients with end-stage renal disease (ESRD).
• To assess changes in LV GLS after kidney transplantation (KT).
• To correlate pre-transplant LV GLS with cardiac structure and function and their post-transplant changes.

Main Methods:

• Retrospective analysis of 488 patients undergoing KT between 2007 and 2018.
• Comprehensive echocardiography including LV GLS assessment by 2D speckle-tracking.
• Patients categorized into three groups based on pre-KT |LV GLS| values.
• Longitudinal comparison of cardiac structure and function pre- and post-KT.

Main Results:

• A significant correlation was found between pre-KT LV ejection fraction (EF) and |LV GLS| (r = 0.292, p < 0.001).
• Patients with severely impaired pre-KT |LV GLS| exhibited larger LV dimensions, mass index, left atrial volume index, and higher E/e', with lower LV EF.
• Following KT, significant improvements in LV EF, LV mass index, and |LV GLS| were observed across all groups, with the most pronounced recovery in those with severely impaired pre-KT |LV GLS|.

Conclusions:

• Kidney transplantation leads to improvements in LV structure and function.
• These benefits are observed across the entire spectrum of pre-transplant LV GLS severity.
• LV GLS is a valuable parameter for assessing cardiac recovery post-KT in ESRD patients.