Echocardiography Predicts Major Adverse Cardiovascular Events after Renal Transplantation

Abstract

Introduction: Cardiovascular disease is a leading cause of morbidity and mortality after renal transplantation. We analysed whether pre-transplant transthoracic echocardiograms (TTE) predicted major adverse cardiovascular events (MACE) after transplant. Methods: We retrospectively analysed clinical and TTE data from patients having renal transplantation at a single centre between 1 January 2000 and 31 December 2010. The TTE were classified as: group A - normal; group B - mild abnormalities expected in renal failure; group C - moderate to severe abnormalities likely to change management. They were also scored based on four independent risk factors [age ≥50, left ventricular (LV) end systolic diameter ≥3.5 cm, LV wall thickness ≥1.4 cm and mitral annulus calcification]. Post-transplantation clinical notes were examined for MACE (death, stroke, myocardial infarction, and surgical or percutaneous revascularisation). Results: There were 343 patients, mean age 47 (range 21-83) years, 210 of whom were male. MACE occurred in 29 (8.5%) at a mean of 3.6 (SD 3.3) years after transplantation. They were older (p ≤ 0.001), had larger LV mass (p = 0.02), LV wall thickness (p = 0.008) and left atrial size (p = 0.001) than those without MACE. The MACE rate for groups A, B and C were 1.8, 13.6 and 16.4% (p ≤ 0.001), respectively. Using the score, the risk of MACE was 4.7, 10.7, 9.2 and 40% for scores 0, 1, 2 and 3 (p = 0.023), respectively. Conclusion: Preoperative transthoracic echocardiography identifies patients at risk of death or non-fatal cardiovascular events even late after renal transplantation. This suggests that echocardiography might be useful to identify patients requiring more aggressive long-term treatment of modifiable vascular risk factors.

Pulmonary hypertension in renal transplant candidates: A systematic review and meta-analysis of the available evidence and a proposed algorithm for pre-transplant management

“…Others analyzed echocardiographic parameters in transplant recipients but did not report PHT as one of their echo parameters and were not included [19,20]. One review of major adverse cardiovascular events (MACE) in renal transplant recipients with and without PHT was evaluated [11]. The statistical analysis included absolute levels of pulmonary pressures in patients who did or did not have MACE after transplantation and did not show a significant difference.…”

“…In the report showing an increased risk of mortality, there was no relationship between PHT and graft survival, a finding that contradicts others [4]. In other publications, the prevalence of PHT was not different in patients with and without major adverse cardiovascular events (MACE) [11]. Renal transplantation may indeed improve PHT in this population [12].…”

The prognostic significance of preoperative left ventricular diastolic dysfunction and left atrial enlargement on acute coronary syndrome in kidney transplantation

“…LAE has been shown to indicate poor prognosis, not only in the general population [ 10 , 19 ] but also in ESRD patients [ 5 , 6 , 20 , 21 ], and KT recipients [ 7 , 9 ]. In addition, it has been proposed that echocardiographic findings of LAE are useful markers of significant hemodynamic changes, which are in turn related to angiographically confirmed CAD [ 22 – 24 ].…”

“…To date, only few reports have examined the association between pre-KT echocardiographic findings and KT outcomes [ 6 – 9 ], and these were limited by small sample size. To the best of our knowledge, this study was conducted with the largest number of KT recipients to date.…”

“…Several baseline echocardiographic abnormalities have been found to have prognostic significance in patients with ESRD [ 3 – 5 ], but only limited data on echocardiographic prognostic factors are available in KT recipients [ 6 – 9 ]. Especially, there has been a lack of relevant research of the effect of pre-KT LVDD and left atrial enlargement (LAE) on posttransplant acute coronary syndrome (ACS).…”