Improvement in right heart function following kidney transplantation in esrd patients: insights from speckle tracking
Mohammad Khani1, Amir Moradi2, Erfan Ghadirzadeh3
1Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Insights
Kidney transplant significantly improves right heart function in end-stage renal disease patients. Echocardiography and strain analysis reveal enhanced right ventricular and atrial performance post-transplant, aiding in predicting outcomes.
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.
Abstract:
Chronic kidney disease (CKD) is commonly associated with unfavorable cardiovascular outcomes and remains the leading cause of mortality in individuals with end-stage renal disease (ESRD). Despite substantial knowledge about the impact of CKD on the left heart, the right heart, which holds significant clinical relevance, has often been overlooked and inadequately assessed in ESRD patients who have undergone kidney transplant (KTx). This study aimed to evaluate the effects of KTx on the right heart chambers in ESRD patients. 57 adult KTx candidates were enrolled in this prospective longitudinal study, while 49 of them were included in the final assessment. Patients underwent a comprehensive cardiac assessment, including conventional echocardiography, speckle tracking echocardiography, and three-dimensional heart modeling both before and after surgery. Echocardiographic assessments showed significant increases in right ventricular (RV) ejection fraction, RV fractional area change (RVFAC), tricuspid annular plain systolic excursion, RV fractional shortening, right atrial (RA) reservoir, conduit, and booster strains, and RV global longitudinal strain (RVGLS). Moreover, significant reductions in RV end-diastolic volume (RVEDV), RV end-systolic volume (RVESV), RV stroke volume, RV end-diastolic diameter (RVEDD) in mid-cavity view, systolic pulmonary artery pressure was observed (all P values < 0.05). However, no significant difference was found in S velocity, as well as RVEDD in basal and apex-to-annulus view. Moreover, pre-KTx measurements of RVGLS, RVEDD (apex-to-annulus diameter), RV fractional shortening, and S velocity were predictors of RVGLS after KTx. RA conduit strain was also identified as a predictor of RA conduit strain after KTx. Additionally, age, RVEDV, RVESV, RVFAC, and RA reservoir strain before KTx were identified as independent predictors of RA reservoir strain after KTx. The findings of this study demonstrate a significant improvement in right heart function following KTx. Furthermore, strain analysis can provide valuable insights for predicting right heart function after KTx.
More Related Videos
09:05Transthoracic Speckle Tracking Echocardiography for the Quantitative Assessment of Left Ventricular Myocardial Deformation
Published on: October 20, 2016
07:13Author Spotlight: Advancing Neonatal Cardiac Diagnostics with Echocardiography-Derived Blood Speckle Imaging
Published on: December 22, 2023
