Midterm echocardiographic follow-up of cardiac function after living kidney donation

Abstract

Background: Living kidney donation (LKD) has become increasingly important as more patients reach end-stage renal disease. While safety of the donor is of utmost importance, recent data have suggested an increased risk for cardiovascular mortality after LKD. Therefore, we assessed the changes of cardiac structure and function after LKD by advanced echocardiographic methods. Methods: 30 living kidney donors were evaluated by medical examination, laboratory testing, and echocardiography before and after LKD (median follow-up 19.5 months). Left ventricular (LV) and right ventricular (RV) function was assessed by echocardiographic standard indices. Longitudinal 2D strain of the LV and left atrium (LA) was determined by 2D speckle tracking. Results: Serum creatinine increased significantly from 0.80 ± 0.12 mg/dL to 1.18 ± 0.21 mg/ dL (p < 0.001) after LKD. There was a trend to higher blood pressure after LKD, accompanied with significantly higher intake of antihypertensive drugs. Echocardiographic parameters of LV, LA, and RV function did not change significantly after LKD. N-terminal pro-brain natriuretic peptide (NT-proBNP) levels remained within normal ranges after LKD. Conclusion: The rise in serum creatinine and blood pressure indicates that patients have a potentially higher cardiac risk after LKD. However, our pilot study found no evidence for detrimental effects of LKD on cardiac structure and function within a relatively short-term follow-up.

Improved Left Ventricular Structure and Function After Successful Kidney Transplantation

“…LV strain of longitudinal shortening as assessed by STE is predominantly influenced by subendocardial fibers. It is more suited to detect subtle changes of LV function than LVEF, which mainly depends on radial and circumferential deformation caused by mid-myocardial and epicardial fibers [17,20]. GLPS is affected by the composition of the interstitial myocardium including the extent of myocardial fibrosis [30] and was shown to be a robust and independent predictor for allcause mortality in patients with severe CKD and impaired LV function [31].…”

“…The trigger was put at the onset of the QRS complex. Peak positive strain (R LA ), strain during early diastole (E LA ) and strain during atrial contraction (A LA ) were determined and LA reservoir (R LA ), conduit (R LA -E LA ) and contractile function (E LA -A LA ) were calculated [18,20].…”

Left atrial strain predicts hemodynamic parameters in cardiovascular patients

“…In our approach, we limit the analysis to the two basal (septal and lateral) LA segments assessed in the apical four‐chamber view. This protocol is highly reproducible, has been established in several previous studies, and has been proven to be easily practicable in clinical routine (see Spethmann et al for details).…”

“…Three different segments of LA strain were determined from the plotted curve: peak systolic strain (LA reservoir function [R LA ]), strain during passive LV filling (conduit phase) in the early diastole (E LA ), and strain during peak atrial contraction (A LA ). LA reservoir function was determined by peak systolic strain, LA conduit, and contractile functions were calculated as R LA –E LA and E LA –A LA , respectively (see Figure for illustration) . In AF patients, only LA reservoir function was determined, as LA contractile function is absent, and thus, E LA cannot clearly be discriminated from the plotted curves.…”

“…Left atrial (LA) dimensions and function are altered in various cardiovascular diseases . In sinus rhythm (SR), three different segments of LA function can be differentiated by speckle tracking echocardiography (STE)‐derived strain analyses: reservoir function (LA filling by pulmonary inflow during ventricular systole), conduit function (passive emptying of the LA during early diastole), and contractile function (active LA emptying by atrial contraction in the late diastole) . In the presence of atrial fibrillation (AF), contractile function is absent.…”