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

Abstract

Echocardiography is commonly performed as a screening test to evaluate perioperative risks before kidney transplantation. However, only limited data are available on echocardiographic parameters of left ventricular diastolic dysfunction (LVDD) and left atrial enlargement (LAE) on acute coronary syndrome and mortality in kidney transplant recipients. We reviewed 2779 adult recipients who underwent pretransplant echocardiography from 1997 to 2012. We divided the patients into two and four groups by two categories: LVDD grades 0–1 vs. 2–3, and left atrial size quartile groups. During a mean follow-up of 4.5 years, acute coronary syndrome occurred in 89 (3.2%) patients. The recipients with LVDD grades 2–3 (P = 0.005 for non-fatal, P = 0.02 for fatal/non-fatal) and LAE (P = 0.001 for non-fatal, P = 0.03 for fatal/non-fatal) had a higher incidence of acute coronary syndrome after kidney transplantation. All-cause mortality did not differ significantly between the groups. In a multivariate analysis, LVDD of grades 2–3 (hazard ratio 2.98, 95% confidence interval 1.535–5.787; P = 0.001), and LAE (hazard ratio 1.052, 95% confidence interval 1.006–1.101; P = 0.03) were independently associated with non-fatal acute coronary syndrome. In patients who are kidney transplant candidates, pretransplant LVDD and LAE were independently associated with a higher incidence of acute coronary syndrome after kidney transplantation.

New Approaches to Cardiovascular Disease and Its Management in Kidney Transplant Recipients

“…176,177 In 1 study, higher incidence of post–kidney transplant acute coronary syndrome was found in patients who had diastolic dysfunction on a pretransplant echocardiogram. 178 Although it remains difficult to predict, several studies have demonstrated that kidney transplantation likely improves diastolic function. 179-182…”

“…176,177 In 1 study, higher incidence of postkidney transplant acute coronary syndrome was found in patients who had diastolic dysfunction on a pretransplant echocardiogram. 178 Although it remains difficult to predict, several studies have demonstrated that kidney transplantation likely improves diastolic function. [179][180][181][182] In contrast to the treatment of heart failure with reduced ejection fraction (HFrEF), there are limited randomized controlled trials examining the treatment of patients with HFpEF.…”

Left atrial global function in chronic heart failure patients with functional mitral regurgitation after MitraClip

“…MR, as reflux of a relevant volume during systole, causes chronic volume overload and consecutive enlargement of the left atrium (LA), followed by LA remodeling. 1,2 Of note, chronically increased preload aggravates progressive heart failure and leads to recurrent hydropic decompensations.…”

Diastolic Dysfunction, an Underestimated New Challenge in Dialysis

“…Kidney transplantation (KT) recipients have demonstrated an improved survival and a significant reduction in LVDD rates after the KT. It may be caused by resolved occult volume overload, restoring renal function, interrupting the ongoing stressors related to dialysis, as well as improving other mediators of HF such as anemia and inflammatory markers . Despite the potential benefits of KT on cardiac function, cardiovascular death remains the most frequent cause of death in KT recipients.…”

“…Despite the potential benefits of KT on cardiac function, cardiovascular death remains the most frequent cause of death in KT recipients. One study suggested that LVH pre‐KT, ventricular dilatation, and systolic dysfunction were associated with higher all‐cause mortality and CV mortality after KT . Concerning DD specifically less is known.…”