Effects of renal transplantation on left ventricular size and function.

Ikäheimo, Markku J.; Linnaluoto, Markku K.; Huttunen, K; Takkunen, Juha T.

doi:10.1136/hrt.47.2.155

Cited by 30 publications

(21 citation statements)

References 13 publications

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“…The study by Larsson et al [14] focusing on young diabetic patients and another by Cueto-Garcia et al [15] on young nondiabetic patients demonstrated signifi cant LV hypertrophy regression after RT with a significant systolic BP decrease. Other stud ies in adult RT patients have also shown a BP decrease and LV hypertrophy decrease [16,17]. However, in the only 2 follow-up studies with no LV hypertrophy regression BP re mained unchanged [18,19].…”

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confidence: 99%

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

Peteiro¹,

Alvarez²,

Calviño³

et al. 1994

Cardiology

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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.

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confidence: 99%

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

Peteiro¹,

Alvarez²,

Calviño³

et al. 1994

Cardiology

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“…Echocardiographie studies in adults and children before and after transplantation show primarily a reduction in ventricular volume and mass, and normalization of car diac output values following transplantation [17][18][19], Striking improvement in ejection fraction after trans plantation may occur [20]. Whether this is due to im provement in anemia or hyperparathyroidism or the absence of uremic toxins is unknown.…”

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confidence: 99%

Low-Output Left Ventricular Failure in End-Stage Renal Disease

et al. 1987

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To determine the factors associated with low-output left ventricular failure (LVF) in endstage renal disease (ESRD), we performed echocardiography and gated cardiac scan on 217 nondiabetic dialysis and transplant patients. The prevalence of low-output LVF (ejection fraction < 55% and left ventricular end diastolic diameter s≥ 5.5 cm) in dialysis patients was 18% and in transplant patients 2%. The 26 patients with LVF were compared to 52 controls without LVF, matched by age, sex and year of starting treatment for ESRD, but not for current ESRD therapy. Mean age was 55 ± (SEM) 14 years; 73% of the patients in both groups were males. Duration of treatment for ESRD was 5.6 ± 4.3 years in patients, compared to 5.1 ± 4.1 years in controls. Significant differences between LVF patients and controls included current treatment (73% of cases were on hemodialysis and 8% were transplanted, compared to 48 and 42%; χ² = 9.9, p < 0.01), high serum creatinine, smoking and high serum alkaline phosphatase. There were no differences for current blood pressure, proportion on treatment for hypertension, left ventricular wall thickness, symptomatic ischemic heart disease, proportion with functioning vascular access, degree of weight gain between dialyses, hemoglobin level or high transfusion requirement. Multiple logistic regression demonstrated the most significant and independent variables associated with LVF were high alkaline phosphatase (suggestive of hyperparathyroidism), smoking and high serum creatinine levels (reflecting degree of uremia). Dialysis patients with LVF (n = 23) were compared to dialysis patients who had normal echocardiograms (n = 29). Using multiple logistic regression, the 3 most important variables associated with LVF were age, high serum alkaline phosphatase and smoking. We conclude that the most important factors associated with LVF in ESRD include age, hyperparathyroidism, smoking and degree of uremia.

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“…Most have shown that LVH regresses but does not normalize following transplantation. 5-8, [19][20][21][22][23][24][25][26] In Table 1 Risk factors identified by studies of vascular disease in renal transplant recipients (see also …”

Section: Risk Factors For Left Ventricular Hypertrophymentioning

confidence: 99%

Therapy Insight: management of cardiovascular disease in the renal transplant recipient

Rigatto

Parfrey

2006

Nat Rev Nephrol

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Cardiovascular disease causes the deaths of up to 50% of renal transplant recipients who have a functioning graft. As in other states of chronic kidney disease, both overload cardiomyopathy (chronic heart failure and left ventricular hypertrophy) and ischemic heart disease are evident; age and gender are important risk factors for both of these disorders. Potentially treatable risk factors include smoking, hyperlipidemia, diabetes and hypertension for ischemic heart disease, and anemia, hypertension and diabetes for cardiomyopathy. Although definitive evidence on the effectiveness of interventions is lacking, it seems reasonable to treat renal transplant recipients as patients at the highest risk of cardiovascular disease. Aggressive targeting of lifestyle factors, blood pressure, cholesterol and sugar regulation is likely to have a major impact on patient and graft survival and should be initiated well before transplantation. Maintenance of hemoglobin with erythropoietic agents is controversial but might improve quality of life. Although immunosuppressive agents have distinct effects on cardiovascular risk factors, the impact on outcomes is impossible to predict on the basis of current data, and no firm recommendations can be made.

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Effects of renal transplantation on left ventricular size and function.

Cited by 30 publications

References 13 publications

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

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

Low-Output Left Ventricular Failure in End-Stage Renal Disease

Therapy Insight: management of cardiovascular disease in the renal transplant recipient

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