Reverse Remodeling and Prognosis Following Kidney Transplantation in Contemporary Patients With Cardiac Dysfunction

Hawwa, Nael; Shrestha, Kevin; Hammadah, Muhammad; Yeo, Poh Shuan Daniel; Fatica, Richard; Tang, W.H. Wilson

doi:10.1016/j.jacc.2015.08.023

Cited by 80 publications

(109 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In accordance with previous studies [5,22,24,25], we were able to show that restoration of renal function by KTX ameliorated blood pressure control after KTX and significantly reversed LVH. Of note, all of the investigated 31 kidney transplant recipients in the present study were successfully transplanted (defined as the absence of maintenance dialysis since the date of KTX and a significant improvement of GFR).…”

Section: Discussionsupporting

confidence: 92%

“…Improvement of LV systolic function (as determined by LVEF assessment) after KTX was shown in patients with moderately reduced LV systolic function and occurs within a relatively short-term follow-up after KTX [5,28]. In the present study, most patients had preserved or mildly impaired LVEF before KTX, which might explain why we observed only a slight, non-significant increase in LVEF.…”

Section: Discussionsupporting

confidence: 38%

“…While cardiac changes are initially adaptive they may aggravate with progressing CKD, finally leading to cardiac failure. Restoration of renal function after kidney transplantation (KTX) disrupts the negative cardiorenal interplay and may reverse some of the cardiac changes seen with CKD [5,6]. KTX was shown to reduce cardiac mortality and the risk for development of chronic heart failure (CHF) compared with long-term dialysis [7].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Improved Left Ventricular Structure and Function After Successful Kidney Transplantation

Hewing

Dehn

Staeck

et al. 2016

Kidney Blood Press Res

View full text Add to dashboard Cite

Background/Aims: Cardiac changes observed in chronic kidney disease patients are of multifactorial origin including chronic uremia, hemodynamics or inflammation. Restoration of renal function by kidney transplantation (KTX) may reverse cardiac changes. Novel echocardiographic methods such as speckle tracking echocardiography (STE) allow early and sensitive detection of subtle changes of cardiac parameters. We evaluated changes of cardiac structure and function after KTX by advanced echocardiographic modalities. Methods: Thirty-one KTX recipients (female n=11) were evaluated by medical examination, laboratory testing and echocardiography before and after KTX (median follow-up 19 months). Left ventricular (LV) and right ventricular (RV) diameters and function were assessed by echocardiographic standard parameters. Longitudinal 2D strain of the LV (GLPS) and left atrium (LA) was determined by 2D STE. Results: After KTX, median serum creatinine level was 1.3 mg/dl (IQR, 1.2-1.5). Systolic blood pressure decreased significantly after KTX. Echocardiography showed a significant reduction in LV end-diastolic septal and posterior wall thickness and LV mass index after KTX, which was accompanied by an improvement of GLPS. There were no relevant changes in parameters of LA (reservoir, conduit or contractile) function, LV diastolic or RV function after KTX. Conclusion: LV hypertrophy reversed after successful KTX and was accompanied by an improvement in longitudinal LV function as assessed by STE. Diastolic function and STE-derived LA function parameters did not change significantly after KTX.

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 38%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Improved Left Ventricular Structure and Function After Successful Kidney Transplantation

Hewing

Dehn

Staeck

et al. 2016

Kidney Blood Press Res

View full text Add to dashboard Cite

show abstract

“…Recently, Toblli et al ., in a small randomized trial in patients with HFrEF, ID, and chronic kidney disease, showed that iron sucrose administration translated into a significant 6‐month improvement in LVEF by echocardiography estimation (6.6 ± 3.8%) 5. More recently, findings from a cohort of 232 patients undergoing renal transplantation showed an increase of LVEF, particularly notorious in those with systolic dysfunction pretransplantation 15. Because these changes were strongly and positively related to haemoglobin changes following transplantation, the authors speculated a potential causal link between ID‐anaemia and HF progression in patients with chronic renal failure 15.…”

Section: Discussionmentioning

confidence: 99%

Left ventricular ejection fraction recovery in patients with heart failure treated with intravenous iron: a pilot study

et al. 2016

View full text Add to dashboard Cite

AimsIn patients with heart failure with reduced ejection fraction (HFrEF) and iron deficiency, treatment with intravenous iron has shown a clinical improvement regardless of anaemic status. Cardiac magnetic resonance (CMR) T2* sequence has shown a potential utility for evaluating myocardial iron deficiency. We aimed to evaluate whether T2* sequence significantly changes after ferric carboximaltose (FCM) administration, and if such changes correlate with changes in left ventricle ejection fraction (LVEF).Methods and resultsIn this pilot study, we included eight patients with chronic symptomatic (New York Heart Association II–III) HFrEF and iron deficiency. A CMR, including T2* analysis, was performed before and at a median of 43 days (interquartile range = 35–48) after intravenous FCM administration. Pearson or Spearman correlation coefficient (r) was used for bivariate contrast as appropriate. A partial correlation analysis was performed between ΔLVEF and ΔT2* while controlling for anaemia status at baseline. Anaemia was present in half of patients. After FCM administration, T2* decreased from a median of 39.5 (35.9–48) to 32 ms (32–34.5), P = 0.012. Simultaneously, a borderline increase in median of LVEF [40% (36–44.5) to 48.5% (38.5–53), P = 0.091] was registered. In a bivariate correlational analysis, ΔT2* was highly correlated with ΔLVEF (r = −0.747, P = 0.033). After controlling for anaemia at baseline, the association between ΔT2* and ΔLVEF persisted [r(partial): −0.865, R 2(partial): 0.748, P = 0.012]. A median regression analysis backed‐up these findings.ConclusionsIn a small sample of patients with HFrEF and iron deficiency, myocardial iron repletion assessed by CMR was associated to left ventricular remodelling. Further studies are warranted.

show abstract

“…10 In addition, assessment of LV mass can be used to monitor response to therapies such as weight reduction 11 or kidney transplantation. 12 Previous work demonstrated the feasibility of using cardiac MRI to derive LV mass in vivo in animals, with excellent correlation to actual measured LV mass ex vivo. 13,14 Additional research optimized cardiac MRI methods for the quantification of LV mass in dogs, leading to high reproducibility and low standard error, 15 with similar results in humans demonstrated by excellent intra-and inter-observer variability.…”

mentioning

confidence: 96%

Assessment of left ventricular mass by SPECT MPI

Packard

Maddahi

2019

Journal of Nuclear Cardiology

View full text Add to dashboard Cite

A. Gimelli, R. Liga et al. report on left ventricular (LV) mass determination using two commercially available softwares that they applied to cadmium-zinc-telluride (CZT) single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), and compared results to cardiac magnetic resonance imaging (MRI) which was the reference standard. 1 For their study, they retrospectively identified n = 25 patients who underwent MPI with gated 99m Tc-tetrofosmin acquired on a CZT camera and had a cardiac MRI within 12 ± 3 weeks. To put the authors' work on LV mass determination in perspective, we will address the importance, accepted methods, and nuclear imaging approaches to LV mass measurement.A common cardiac adaptive mechanism in the setting of hemodynamic overload is the compensatory increase in LV mass, as explained by the Law of LaPlace in whichwhere s is the ventricular wall stress, P is the ventricular pressure, r is the ventricular radius, and T is the ventricular wall thickness. 2 However, this compensatory increase in ventricular wall thickness is detrimental on the long run, as demonstrated by multiple clinical studies. Indeed, an increase in LV wall thickness or mass, typically due to left ventricular hypertrophy (LVH), predicts an increased risk of cardiovascular morbidity and mortality as determined in the Framingham Heart Study, even after adjustment for major risk factors. 3 Moreover, the severity of LVH is an independent predictor of death and coronary revascularization. 4 These early observations have been confirmed by more contemporary data where LV mass and LVH were found to be predictive of the need for future revascularization, 5 and of the occurrence of myocardial infarction and cardiac death 6 in patients with or without stress-inducible ischemia 7 or in the setting of asymptomatic aortic stenosis. 8 In patients with a previous myocardial infarction, prognosis is related to the percentage of viable LV mass, and LV mass measurement can assess the development of compensatory focal LVH. 9 Quantification of LV mass is also useful in the evaluation and management of patients with valvular heart disease and hypertrophic cardiomyopathy. Further, LV mass has been demonstrated to predict the incidence of congestive heart failure in the Multi-Ethnic Study of Atherosclerosis. 10 In addition, assessment of LV mass can be used to monitor response to therapies such as weight reduction 11 or kidney transplantation. 12

show abstract

Reverse Remodeling and Prognosis Following Kidney Transplantation in Contemporary Patients With Cardiac Dysfunction

Cited by 80 publications

References 33 publications

Improved Left Ventricular Structure and Function After Successful Kidney Transplantation

Improved Left Ventricular Structure and Function After Successful Kidney Transplantation

Left ventricular ejection fraction recovery in patients with heart failure treated with intravenous iron: a pilot study

Assessment of left ventricular mass by SPECT MPI

Contact Info

Product

Resources

About