Cardiovascular Comorbidities Are the Main Predictors of Cardiac Reverse Remodeling following Kidney Transplantation

Abstract

Background: End-stage renal disease is associated with cardiac remodeling, which is partly reversible after kidney transplantation (KT). We aimed to determine the association of cardiovascular comorbidities or kidney-related factors with cardiac reverse remodeling after KT. Methods: We performed echocardiography in 56 patients (aged 48 ± 15 years, mean ± SD) before and 24 months after undergoing their first KT. Echocardiograms were reviewed using a standardized process with blinding for the patient characteristics and evaluation timing. Multivariable linear regression analysis was used to evaluate the association between comorbidities and changes in cardiac structure and systolic/diastolic function. Results: Left ventricular mass index (LVMI) and diastolic parameters did not change significantly, while left ventricular ejection fraction (LVEF) increased from 63.9 to 69.6% (p = 0.046). Multivariable analysis revealed associations of histories of valvular heart disease with a smaller reduction in LVMI (β = –27.3, p = 0.04), of coronary artery disease or heart failure with a smaller increase in LVEF (β = 7.17, p = 0.02), and of diabetes mellitus with less improvement in E wave (β = –0.19, p = 0.05), e’ (β = 4.15, p = 0.046), and E/e’ (β = –5.00, p < 0.01). Conclusion: Cardiovascular comorbidities were ­associated with less improvement in cardiac structure and function following KT. Our findings suggest that patients with CV comorbidities may experience limited “favorable” reverse cardiac remodeling following KT.

Left Ventricular Hypertrophy After Renal Transplantation: Systematic Review and Meta-analysis

“…Initially, 7416 references were identified. Forty-six studies, 16–61 involving 4122 participants with a mean age of 46.2 ± 7.6 y and a mean body mass index of 26.4 ± 10.3 kg/m 2 , met the inclusion criteria. Eleven studies were cross-sectional, and 35 were longitudinal.…”

A review of biomarker and imaging monitoring to predict heart failure recovery

“…Many studies have sought to determine prognostic indicators of reverse remodeling and clinical outcomes. Baseline clinical parameters, biomarkers, and imaging findings, such as nonischemic cause, female sex, and baseline LVEF, show strong predictive value (10)(11)(12)(13)(14)(15)(16). While helpful, baseline considerations reflect a single timepoint and, therefore, cannot be used in realtime to track or predict disease progression to modify or personalize treatment plans.…”