Left ventricular function before and after kidney transplantation. A prospective study in patients with juvenile-onset diabetes mellitus

Abstract

The aim of the present investigation was to discover whether disturbed left ventricular (LV) function limits renal replacement therapy in patients with juvenile onset diabetes mellitus. Seventeen patients given functioning kidney grafts were studied non-invasively (M-mode echocardiography, apexcardiography, phonocardiography) before renal transplant and an average of six, 13 and 44 months after transplant. The main pretransplant findings were pronounced LV hypertrophy with impaired diastolic LV function (prolonged relaxation time + signs of decreased LV distensibility) and a hyperdynamic circulation. Most of these abnormalities were significantly less severe after successful kidney transplantation. LV mass decreased by 37% 44 months after transplant (p less than 0.01) and LV diastolic and systolic volumes decreased with a subsequent increase in ejection fraction from 0.65 to 0.78 (p less than 0.01). The LV distensibility and filling pattern improved significantly while the prolonged relaxation time was unchanged. These findings imply that pretransplant disturbances in LV function are related more to factors such as hypertension, volume overload and uraemia than to diabetes per se because no pronounced improvement in the metabolic disorder resulting from diabetes can be expected, even after the most successful transplant. Disturbed LV function should not, therefore, exclude uraemic diabetics from renal replacement.

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

“…How ever, isolated values of peak early and late transmitral velocities were not reported. On the other hand, the study by Larsson et al [ 14] on 17 kidney-transplanted diabetic patients showed a 31 % decrease in active atrial filling 44 months after RT, with no change in pas sive filling and LV relaxation time index. There was also LVM, volume, and BP regres sion.…”

“…Several previous follow-up studies pro duced different findings regarding LVM re duction after RT. 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].…”

Echocardiographic findings in kidney transplanted Type 1 (insulin-dependent) diabetic patients with and without a pancreas transplant

“…In spite of this almost inevitable experience in this disease, left ventricular systolic function was well preserved in all patients. In fact, left ventricular systolic and diastolic function have been reported to improve and the left ventricular mass to be reduced following kidney transplantation in Type 1 diabetic patients (Larsson et al 1986). Much of what was previously considered to be primary, early or late, effects of the diabetic state on cardiac function has thus been shown to be consequences of hypertension and renal insufficiency.…”

Efeito do transplante renal na morfologia e função cardíaca

“…in spite of the small samples involved, those studies already pointed to a trend towards decreased cardiac volumes after the procedure, 21 as well as improved parameters of systolic function 22 and early regression (three weeks) of Lv mass index. 23 Specifically assessing a group of patients with juvenile diabetes, Larsson et al 24 observed a significant 37% reduction of the ventricular mass, 44 months after renal transplantation, besides a reduction of the Lv systolic and diastolic volumes, with consequent increase of the ejection fraction and better Lv distensibility and filling patterns.…”