BACKGROUND Cardiac dysfunction influences candidate selection for kidney transplantation. There is a paucity of data regarding predictors of myocardial recovery following kidney transplantation as well as long-term outcomes. OBJECTIVES The purpose of this study was to identify the extent of reverse remodeling in our kidney transplant population as well as predictors of such changes and assess outcomes in these patients. METHODS We reviewed 232 patients who underwent kidney transplantation at the Cleveland Clinic from 2003 to 2013 and had baseline and post-transplant echocardiograms, excluding those with simultaneous heart transplantation. RESULTS Post-transplant median left ventricular ejection fraction (LVEF) improved in those with left ventricular (LV) dysfunction (increased from 41% to 50%; p < 0.0001; n = 66). There was significant improvement in other parameters including diastolic function, LV end-diastolic dimension, LV mass, and right ventricular systolic pressure. After adjusting for multiple clinical variables, increased hemoglobin following transplantation was associated with improved LVEF (odds ratio: 1.50; 95% confidence interval [CI]: 1.07 to 2.14; p = 0.016) and reduced mortality (hazard ratio [HR]: 0.65; 95% CI: 0.49 to 0.87; p = 0.004). Improved LVEF ≥10% predicted survival independent of pre-transplant LVEF (HR: 0.46; 95% CI: 0.21 to 0.93; p = 0.031). CONCLUSIONS Kidney transplantation is associated with improved cardiac structure and function. A rise in post-transplant hemoglobin was a significant factor associated with such changes, in addition to conferring a survival advantage.

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Ranolazine is currently approved for use in chronic angina. The basis for this use is likely related to inhibition of late sodium channels with resultant beneficial downstream effects. Randomized clinical trials have demonstrated an improvement in exercise capacity and reduction in angina episodes with ranolazine. This therapeutic benefit occurs without the hemodynamic effects seen with the conventional antianginal agents. The inhibition of late sodium channels as well as other ion currents has a central role in the potential use of ranolazine in ischemic heart disease, arrhythmias, and heart failure. Despite its QTc-prolonging action, albeit minimal, clinical data have not shown a predisposition to torsades de pointes, and the medication has shown a reasonable safety profile even in those with structural heart disease. In this article we present the experimental and clinical data that support its current therapeutic role, and provide insight into potential future clinical applications.

A 42-year-old man presented with a viral prodrome and tested positive for influenza A. He rapidly deteriorated developing cardiogenic shock, rhabdomyolysis, and acute kidney injury. Patient improved 1 week later with supportive measures including vasopressors, inotropes, and an intraaortic balloon pump. We report this case as it highlights the discordance between echocardiographic ventricular wall thickening as a result of myocardial edema, and electrocardiographic findings at presentation, with a reversal in findings at time of resolution. Additionally, there was some suggestion of a regional pattern to the reduced longitudinal strain.