Improvement in right heart function following kidney transplantation in esrd patients: insights from speckle tracking...

Area of Science:

• Cardiology
• Nephrology
• Transplantation Medicine

Background:

• Chronic kidney disease (CKD) is linked to poor cardiovascular health and high mortality in end-stage renal disease (ESRD) patients.
• The impact of CKD on the right heart is often underestimated in ESRD patients, particularly those undergoing kidney transplantation (KTx).
• Assessing right heart function is crucial for managing cardiovascular risks in ESRD and post-KTx.

Purpose of the Study:

• To prospectively evaluate the effects of kidney transplantation (KTx) on right heart chamber function in ESRD patients.
• To identify predictors of post-KTx right heart function using pre-transplant cardiac assessments.

Main Methods:

• A prospective longitudinal study involving 49 adult kidney transplant candidates.
• Comprehensive cardiac assessment including conventional echocardiography, speckle tracking echocardiography, and 3D heart modeling before and after KTx.
• Analysis of right ventricular (RV) and right atrial (RA) parameters, including ejection fraction, fractional area change, strains, and volumes.

Main Results:

• Significant improvements observed in RV ejection fraction, RV fractional area change, RV global longitudinal strain (RVGLS), and RA reservoir, conduit, and booster strains post-KTx (P < 0.05).
• Significant reductions in RV end-diastolic volume (RVEDV), RV end-systolic volume (RVESV), and systolic pulmonary artery pressure were noted post-KTx (P < 0.05).
• Pre-KTx RVGLS, RVEDD, RV fractional shortening, S velocity, and RA conduit strain predicted post-KTx function; age, RVEDV, RVESV, RVFAC, and RA reservoir strain independently predicted RA reservoir strain.

Conclusions:

• Kidney transplantation leads to significant functional improvements in the right heart chambers of ESRD patients.
• Strain analysis, particularly RVGLS and RA strains, is valuable for assessing and predicting right heart function after KTx.
• These findings highlight the beneficial impact of KTx on cardiovascular health, specifically right heart function, in ESRD.