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Association of Pre-Transplant Left Ventricular Longitudinal Strain With Long-Term Cardiovascular Outcomes Following
Zalan Shah1, Ava Delonais-Parker1, Yanqing Lyu2
1Saint Louis University School of Medicine, St. Louis, Missouri, USA.
Insights
Left ventricular global longitudinal strain (GLS) can identify cardiac dysfunction in kidney transplant recipients (KTRs). Abnormal GLS independently predicts major adverse cardiovascular events (MACE) in KTRs, aiding cardiovascular risk assessment.
Area of Science:
- Cardiology
- Nephrology
- Transplantation Medicine
Background:
- Cardiovascular disease (CVD) is the primary cause of mortality in kidney transplant recipients (KTRs).
- Left ventricular global longitudinal strain (GLS) is recommended for early cardiac dysfunction detection, but its utility in KTRs is understudied.
Purpose of the Study:
- To investigate the association between pre-transplant left ventricular global longitudinal strain (GLS) and major adverse cardiovascular events (MACE) in kidney transplant recipients (KTRs).
- To determine if GLS can serve as a predictor of cardiovascular risk in KTRs.
Main Methods:
- Retrospective cohort study of 341 adult KTRs undergoing kidney transplantation (KT) with pre-transplant echocardiograms.
- Patients were categorized into normal GLS (NGLS) and abnormal GLS (AbGLS) groups based on vendor-independent speckle-tracking analysis (AbGLS < 16%).
- Major adverse cardiovascular events (MACE) were tracked over a mean follow-up of 52.7 months, with survival analysis using Kaplan-Meier curves and Cox proportional hazards models.
Main Results:
- Patients with abnormal GLS (n=182) were older and had higher rates of hypertension, diabetes, and coronary artery disease compared to those with normal GLS (n=159).
- The 5-year cumulative incidence of MACE was significantly higher in the AbGLS group (27.1%) versus the NGLS group (9.4%) (log-rank p=0.002).
- In multivariable analysis, GLS was independently associated with MACE (adjusted HR 0.94; p=0.04), while left ventricular ejection fraction was not.
Conclusions:
- Pre-transplant left ventricular global longitudinal strain (GLS) is an independent predictor of major adverse cardiovascular events (MACE) in kidney transplant recipients (KTRs).
- GLS may play a valuable role in cardiovascular risk stratification for kidney transplant candidates.
Purpose:
Cardiovascular disease (CVD) remains the leading cause of death among kidney transplant recipients (KTRs). Current guidelines recommend using left ventricular global longitudinal strain (GLS) for the early identification of cardiac dysfunction, but its value in KTRs has not been well studied.
Methods:
We performed a single-center retrospective cohort study of adult KTRs who underwent KT between January 2015 and January 2024 and had an adequate-quality pre-transplant echocardiogram. Patients without follow-up at our institution or with atrial fibrillation were excluded. GLS was measured using vendor-independent two-dimensional speckle-tracking software, with abnormal GLS defined as absolute GLS < 16% (lower absolute strain magnitude), with higher values indicating better systolic function. Patients were divided into normal GLS (NGLS) or abnormal GLS (AbGLS) groups. The primary outcome was major adverse cardiovascular events (MACE), defined as cardiovascular death, acute coronary syndrome, stroke, hospitalization for heart failure, or major arrhythmia. Kaplan-Meier survival curves and Cox proportional hazards models were constructed for statistical analysis.
Results:
Of 518 screened KTRs, 341 met the study criteria. Compared with NGLS patients (n = 159), AbGLS patients (n = 182) were older (55.1 vs. 51.5 years) and had a significantly higher prevalence of hypertension, diabetes mellitus, and coronary artery disease. Over a mean follow-up of 52.7 ± 28.3 months, Kaplan-Meier analysis demonstrated a significantly higher cumulative incidence of MACE in the AbGLS group, with a 5-year incidence of 27.1% versus 9.4% in NGLS (log-rank p = 0.002). In multivariable Cox regression adjusted for confounding variables identified from univariate regression, GLS was independently associated with MACE (adjusted HR 0.94; 95% CI 0.88-1.00; p = 0.04), whereas left ventricular ejection fraction was not.
Conclusion:
In this retrospective single-center study, GLS was independently associated with MACE in KTRs, supporting a potential role for GLS in cardiovascular risk assessment in KT candidates.
