Changes in Left Ventricular Mass and Filling after Renal Transplantation Are Related to Changes in Blood Pressure: An Echocardiographic and Pulsed Doppler Study

Abstract

To examine changes in left ventricular (LV) mass and function (diastolic and systolic) after successful renal allograft transplantation (RT), we prospectively studied 30 patients (19 men, 11 women, aged 37 ± 13 years) by M-mode, two-dimensional and pulsed Doppler echocardiography at the time of surgery and 10 ± 1.8 months later. At the time of transplantation all patients had been undergoing dialysis (4 peritoneal dialysis, 26 hemodialysis) for 2.5 ± 3.2 years. A hematocrit of ≤30% was present in 26 patients. After RT the mean hematocrit increased from 26 ± 4 to 40 ± 7 (p < 0.01), whereas systolic, diastolic and mean blood pressure (BP) remained unchanged. The LV mass index (LVMI) decreased from 201 ± 56 to 171 ± 41 g/m², (p < 0.01); LV diastolic diameter corrected by body surface area (LVDDI) decreased from 298 ± 38 to 279 ± 35 (p < 0.01) and the LV end-diastolic volume index (LVEDVI) from 72 ± 18 to 63 ± 15 (p < 0.01). There were no changes in LV fractional shortening or LV end systolic wall stress. Peak late transmitral velocity (A wave) decreased from 77 ± 16 to 68 ± 12 cm/s (p < 0.01) with no changes in other Doppler-derived indexes of diastolic function. No fistula patency influence on changes in LV mass and function was found. After RT, BP decreased in 21 patients from 150 ± 20 to 132 ± 15 (p < 0.001; group I) and increased in 9 patients from 130 ± 14 to 153 ± 16 (p < 0.05, group II). Patients in group I suffered a reduction in LVMI (p < 0.001), LV end-diastolic diameter (p < 0.05), LVDDI (p < 0.001); LV end-diastolic volume (p < 0.05); LVEDVI (p < 0.01); cardiac index (p < 0.05), and peak late transmitral velocity (p < 0.01), but no changes in group-II patients were observed. We concluded that BP is a major determining factor with regard to changes in LV hypertrophy and function following RT. LV mass and volumes can be expected to decrease after RT in patients with BP reduction.

Cardiac Effects of Persistent Hemodialysis Arteriovenous Access in Recipients of Renal Allograft

“…In dialysis patients with a long-term AV fistula, Ponsin et al [5]reported a significant correlation between the signs of cardiac insufficiency and the fistula blood flow × fistula duration product. In two recent reports on renal transplant patients with normal or near-normal cardiac function, however, the persistence of an AV fistula did not influence LV mass or other echocardiographic parameters [2, 3]. We found that the persistence of even large, high-flow AV fistulas for prolonged periods of time did not significantly influence the LV mass and had little impact on cardiac morphology and function.…”

“…Left ventricular (LV) hypertrophy is a well-established cardiovascular risk factor which is frequently observed in renal transplant recipients [1, 2, 3]. There is scant information on the cardiac effects of patent arteriovenous (AV) fistulas in recipients of renal transplants.…”

Kidney Disease as a Risk Factor for Development of Cardiovascular Disease

“…Remodeling ʈData from Kasiske. 10 ¶Data from Parfrey et al, 11 Hernandez et al, 12 Peteiro et al, 13 Huting et al, 14 often accompanies a reduction in arterial compliance, which can be detected through measurement of aortic pulse wave velocity and characteristic impedance. 34,35 Noncompliant vessels may result in increased systolic blood pressure, increased pulse pressure, LVH, and decreased coronary perfusion.…”

“…The prevalence of coronary artery disease is Ϸ15%, 10 the prevalence of LVH is 50% to 70%, [11][12][13][14][15] and the incidence of CVD is at least 3 to 5 times that of the general population. 6,10 Risk factors for CVD in kidney transplant recipients are multiple.…”

The Evaluation of the Renal Transplant Candidates: Clinical Practice Guidelines

“…LVH is associated with increased mortality on hemodialysis (736) and peritoneal dialysis (738). Although LVH often improves after renal transplantation (739)(740)(741)(742), it nevertheless predicts a worse posttransplant outcome (741,742). Even in the absence of randomized controlled trials it is reasonable to conclude that correcting LVH in hemodialysis patients may reduce risk and improve outcomes while on the waiting list and after renal transplantation.…”