Risk factors for global longitudinal strain impairment in renal transplant recipients with preserved left ventricular ejection fraction

Abstract

Background . Patients with chronic kidney disease, including these after kidney transplantation (KTx), have higher cardiovascular mortality. Global longitudinal strain (GLS) detects subtle changes in the left ventricle (LV) and is more sensitive predictor of cardiovascular mortality than the LV ejection fraction (LVEF).The aim of this study was to assess the prevalence of impaired GLS among kidney transplant recipients with preserved LVEF. We also aimed to identify possible clinical factors responsible for GLS impairment. Methods . A total of 79 patients following KTx with preserved LVEF and no history of cardiac disease were evaluated. We assessed echocardiogram parameters with the calculation of GLS, laboratory parameters, presence of diabetes, hypertension, duration of haemodialysis (HD) and time after KTx. An impaired GLS value was set on ≥-18%. The Classification and Regression Trees and stepwise logistic regression analysis were used to identify the factors related to impaired GLS. Results. Among 79 (42 females, mean age 60.3) kidney transplant recipients with preserved LVEF, 39% had impaired GLS. In stepwise logistic regression analysis, two variables related with GLS≥-18%: duration of HD before KTx longer than 27.5 months (OR 4.48, 95% CI 1.46-14.38, P=0.01), and eGFR greater than 60mL/min/1.73m2 (OR 0.155, 95% CI 0.024-0.967, P= 0.049). Conclusions. In our study group, a total of 39% of KTx patients with preserved LVEF had impaired GLS. The main risk factor of GLS impairment was the prolonged time of HD (>27.5 months) prior to KTx, whereas a good renal graft function (eGFR>60mL/min/1.73m2) only marginally proved to be a protective factor.