Early echocardiographic changes and survival following renal transplantation

McGregor, E.; Stewart, Graham; Rodger, R. S. C.; Jardine, Alan G.

doi:10.1093/ndt/15.1.93

Cited by 52 publications

(53 citation statements)

References 20 publications

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“…By and large these studies have shown that LV mass decreases posttransplantation and that this decrease parallels posttransplant improvement in BP control (8 -18). Two studies have suggested that pretransplant LVH is predictive of posttransplant mortality in the first 5 yr, but none have had sufficient power and long enough follow-up to examine whether posttransplant persistence or development of LVH are predictive of death and cardiovascular events (21,22). We have previously shown that CHF appears to be more frequent in RTR than in the general population and is independently associated with a twofold increased risk of death.…”

Section: Discussionmentioning

confidence: 98%

Electrocardiographic Left Ventricular Hypertrophy in Renal Transplant Recipients

Rigatto

Foley

Jeffery³

et al. 2003

Journal of the American Society of Nephrology

180

113

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Abstract. Left ventricular hypertrophy (LVH) is an independent risk factor for death and cardiovascular disease in the general population and dialysis patients. However, the causes and consequences of LVH have not been well described in renal transplant recipients (RTR). A retrolective cohort study was conducted in 473 RTR who were alive and free of cardiac disease at 1 yr. LVH was defined using the Cornell electrocardiographic (EKG) criteria. A total of 416 patients had an interpretable first-year EKG (88%), and 284 had an interpretable fifth-year EKG (78% of 5-yr survivors). Baseline characteristics were similar in patients with and without EKG. Of 416 patients, 57 had LVH in the first year, whereas 38 of 284 patients had LVH in the fifth year, of which 18 cases were de novo. Baseline LVH was a risk factor for death (RR 1.9 [1.22, 3.22]) and congestive heart failure (CHF) (RR 2.27 [1.08, 4.81]) and was independent of other major prognostic variables. Persistent or de novo LVH in the fifth year predicted subsequent death (RR 2.15 [1.14,4.01]) and CHF (2.71 [1.17,6.30]). Anemia and diastolic BP were independent risk factors for increasing Cornell voltage (a marker of LV mass) between first and fifth years. Systolic BP was the only predictor of de novo LVH at 5 yr. It seems that EKG LVH is a significant risk factor for death and CHF in RTR and that anemia and hypertension are risk factors for LV growth. Whether aggressive treatment of hypertension and anemia can improve outcomes merits further study.Left ventricular hypertrophy (LVH) is a well-established marker of cardiovascular risk in the general population. Both electrocardiographic (EKG) and echocardiographic (echo) LVH are strong independent predictors of outcome (1,2). EKG and echo have a similar specificity for LVH, but EKG is less sensitive for mild to moderate degrees of hypertrophy (3,4). Electrocardiography is much cheaper and more widely available than echo, however, making it a useful prognostic and epidemiologic tool.In dialysis patients, echo LVH has been shown to predispose to death and congestive heart failure (CHF) (5). The prevalence of echo LVH increases progressively with progression of renal insufficiency (5,6,7). Hypertension and chronic anemia appear to be the dominant stimuli for left ventricular growth in renal failure patients, although age, diabetes, and metabolic factors may also play a role (5,7). In renal transplant recipients, relatively little is known about the causes and consequences of LVH. Most studies have simply documented changes in echo LVH before and after transplantation or in the first few posttransplant years (8 -18). Neither the causes of LVH nor its mortal and cardiovascular consequences have been well described. Moreover, the prognostic value of electrocardiographic LVH has not been assessed in renal transplant patients.In a recently published study of CHF in renal transplant recipients (RTR), we documented that development of CHF incurred a strong adverse risk of death (19). As in dialysis patients, hypertension...

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Section: Discussionmentioning

confidence: 98%

Electrocardiographic Left Ventricular Hypertrophy in Renal Transplant Recipients

Rigatto

Foley

Jeffery³

et al. 2003

Journal of the American Society of Nephrology

180

113

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“…Overall, there was an increase in LVEF and reduction of cavity volumes after transplantation 19,21 , even in the pediatric population 23 . Moreover, Rakhit et al 29 , during a median follow-up of 4.2 years after kidney transplantation showed significant reduction in LVESVi of 33 ml/m 2 to 23 ml/m 2 .…”

Section: Discussionmentioning

confidence: 92%

“…McGregor et al 19 evaluated 67 patients four months after kidney transplantation and showed no impact on ventricular mass, and Patel et al 20 , in a cross-sectional study, also showed no difference in LV mass measured by magnetic resonance imaging in transplanted 21,22 , even in the pediatric population 23 .…”

Section: Discussionmentioning

confidence: 96%

Estudo das alterações ecocardiográficas nos primeiros seis meses após o transplante renal

Souza¹,

Bezerra²,

Sousa³

et al. 2012

Arq. Bras. Cardiol.

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“…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.…”

Section: Recommendationsmentioning

confidence: 99%

“…Severe, irreversible heart failure should probably preclude renal transplantation unless heart transplantation is also considered. However, many patients with mild or moderate (idiopathic) cardiac dysfunction may respond to renal transplantation with an improvement in myocardial function (742,(757)(758)(759)(760)(761)(762)(763)(764)(765). Indeed, most investigators have reported that echocardiographic or radionuclide-determined ejection fraction increases and left ventricular mass decreases after renal transplantation.…”

Section: Recommendationsmentioning

confidence: 99%

The Evaluation of the Renal Transplant Candidates: Clinical Practice Guidelines

2001

American Journal of Transplantation

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Early echocardiographic changes and survival following renal transplantation

Cited by 52 publications

References 20 publications

Electrocardiographic Left Ventricular Hypertrophy in Renal Transplant Recipients

Electrocardiographic Left Ventricular Hypertrophy in Renal Transplant Recipients

Estudo das alterações ecocardiográficas nos primeiros seis meses após o transplante renal

The Evaluation of the Renal Transplant Candidates: Clinical Practice Guidelines

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