Left ventricular mass and heart sympathetic activity after renal transplantation in children and young adults

Abstract

Recent studies considered that an increase in sympathetic activity (SA) may be responsible for left ventricular hypertrophy (LVH). Before and after renal transplantation (RT), we evaluated changes on left ventricular mass (LVM) and SA in 40 end-stage renal disease patients between 8 and 35 years old. Hypertension (95.0% vs. 71.0%; p=0.005), use of combined antihypertensive drugs (57.5% vs. 30.0%; p=0.01), and LVH (77.5% vs. 52.5%; p=0.01) significantly decreased after RT whereas low-to-high frequency ratio (LF/HF), which represents SA, increased (3.1 vs. 5.3; p=0.0001). However, LVM regressors (with decrease on LVM index more than 20%) showed a trend of lower change on LF/HF ratio (1.6 vs. 2.4; p= 0.09) than nonregressors. Living-donor graft, baseline LVM, use of antihypertensive drugs, lower change on LF/HF ratio, and lower systolic blood pressure levels were associated with LVM regression in the simple correlation analysis. However, in the logistic regression analysis, only baseline LVM and donor type remained in the model (R(2)=0.35; p=0.0003). Thus, LVH decreased after RT and was related to baseline LVM and living-donor type. However, it is possible that the higher persistence of LVH after RT could be explained at least in part by increase in heart sympathetic activity and use of immunosuppressors.

Cardiac magnetic resonance imaging in children with chronic kidney disease and renal transplantation

“…We did not find any statistical difference in systolic blood pressure, and it was still high in Tx patients; however, diastolic blood pressure dropped close to the normal range in Tx patients, which might be explained by the better fluid status; although the intraindividual comparison showed no changes. The presence of LVH decreased in our observational study from 80% to 40%, and from almost 90% to 50% in the intraindividual comparison, which is in line with most of the former echocardiographic studies in children (6, 13, 14). In the cross‐sectional study, we did not find any patients with low LVEF after Tx and only one with high LVESVi.…”

“…Several reports have demonstrated that kidney Tx leads to the regression of LVH (6, 13, 14). However, these promising data were obtained by echocardiography which does not allow for accurate monitoring in patients on hemodialysis mainly due to the rapid changes in LV loading states (21) and further disadvantages of 2DE, such as limited access through the intercostal spaces (3), subjective interpretation, high interobserver variability, semiquantitative evaluation of regional systolic LV contraction and the need of geometric assumptions.…”

“…CV mortality is significantly reduced after renal Tx. LVH has been reported to significantly improve in most children after Tx, if blood pressure is well controlled (6, 13, 14). In contrast to that, Kitzmueller et al.…”

Left Ventricular Mass in Dialysis Patients, Determinants and Relation with Outcome. Results from the COnvective TRansport STudy (CONTRAST)

“…The relation between LVM and a history of kidney transplantation [35], [36] and albumin [37] is in accordance with earlier literature.…”

Cardiovascular Autonomic Dysfunction in Chronic Kidney Disease: a Comprehensive Review

“…Studies also have demonstrated that cardiac sympathetic activity is related to LVH in patients with primary [61] or CKDmediated hypertension [62].…”