The prognostic role of myocardial strain indices and dipyridamole stress test in renal transplantation patients

Abstract

Introduction: Renal transplantation (RT) increases survival in end-stage kidney disease patients but cardiovascular diseases remain the leading cause of morbidity and mortality. We evaluated the role of myocardial strain (2DSTE) indices and dipyridamole-induced (DIPSE) changes in echocardiographic parameters at baseline for the prediction of clinical events and echocardiographically assessed deterioration of cardiac function in a RT population. Methods: Forty-five RT patients underwent an echocardiographic study at baseline including 2DSTE and DIPSE. If no cardiovascular/renal event occurred, patients were investigated at 3-year follow-up; eight patients presented a clinical event while 37 patients were re-evaluated. Results: Coronary flow reserve (CFR) was abnormal in 24% of the population. DIPSE induced improvements in classic and 2DSTE systolic and diastolic echocardiographic indices including TWIST, UNTWIST, global longitudinal strain (GLS), and circumferential strain (P < .05 for all). Compared to baseline, deteriorations in E/E', LVEF, E', and TWIST were observed at follow-up (P < .05 for all). DIPSE-induced changes in GLS, global radial strain, and LVEF were associated with changes in these indices at follow-up (P < .05 for all). Higher LV mass index, E/E', and lower MAPSE, E', and CFR at baseline were associated with the occurrence of clinical events at follow-up (P < .05 for all). Conclusions: In RT patients, coronary vascular dysfunction (ie, low CFR) was associated with the occurrence of adverse events. DIPSE-induced changes in myocardial strain and classic echocardiographic indices could identify individuals with a subclinical deterioration in cardiac function at follow-up. This may indicate that DIPSE could serve as a means to assess myocardial reserve in this population. K E Y W O R D S coronary flow reserve, dipyridamole, global longitudinal strain, myocardial strain, renal transplantation | 63 LAKKAS et AL.

Coronary microcirculation and left ventricular diastolic function but not myocardial deformation indices are impaired early in patients with chronic kidney disease

“…CFR is a useful marker non-invasive echocardiographic index of epicardial artery stenosis of the LAD territory and coronary microcirculation; in our study in CKD patients without clinical or subclinical CAD, CFR is more likely to describe coronary microcirculation function [23,[35][36][37][38][39]. In agreement with our findings decreased CFR has been demonstrated in CKD patients even with mild to moderate GFR impairment [18,40,41].…”

“…In agreement with our findings decreased CFR has been demonstrated in CKD patients even with mild to moderate GFR impairment [18,40,41]. Impaired CFR and subsequent dysfunction of coronary microcirculation has been related to LV diastolic dysfunction and other LV structural changes [23,[41][42][43] in various CKD populations as well as to prognosis in CKD patients [42,44,45].…”

“…DIPSE has been previously shown to be effective for both the assessment of myocardial ischemia and CFR assessment. It has also been suggested that it could be used as a test to evaluate the systolic and diastolic myocardial reserve in various populations [23,39,48]. In our study, DIPSE produced similar improvement in various indices of LV systolic and diastolic function (classic and 2DSTE-related) in all three patient groups.These findings suggest that DIPSE test may not be suitable for detecting early myocardial abnormalities and risk stratification in relatively healthy asymptomatic CKD patients free of established cardiovascular disease.…”

“…None of the enrolled patients with CFR values<2 had confirmed significant CAD. Intra-observer variability for all indices of interest included in this study has been previously reported [23].…”

Dipyridamole and adenosinergic pathway in Covid-19: a juice or holy grail

“…As well, SARS-CoV-2 infection is usually interrelated with inhibition of adenosine (AD) as well as activation of PDE [ 7 ]. Since Covid-19 is linked with cardiovascular complications and coagulopathy, the main target of our mini-review study was to elucidate the potential impacts of DIP on the adenosinergic pathway in Covid-19.…”