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Jain M, Bhat R, Grewal HK, Nandwani A, Yadav D, Jha PK, Bansal S, Bansal D, Kher V, Bansal M. Effect of Renal Transplantation on Left Ventricular Myocardial Deformation in Patients With End-Stage Renal Disease. Clin Transplant 2025; 39:e70150. [PMID: 40245173 DOI: 10.1111/ctr.70150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2025] [Revised: 03/12/2025] [Accepted: 03/24/2025] [Indexed: 04/19/2025]
Abstract
BACKGROUND End-stage renal disease (ESRD) is associated with significant left ventricular (LV) remodeling. However, the impact of renal transplantation on LV remodeling has not been adequately elucidated. METHODS A comprehensive echocardiography was performed before and after (median time interval 239 days, interquartile range 149-328 days) renal transplantation in 42 patients (mean age 39.1 ± 11.0 years, 79% men). Forty-five apparently healthy age- and gender-matched controls were also included. RESULTS The patients with ESRD had significantly increased LV mass index, left atrial volume index (LAVI), and the ratio of early diastolic mitral inflow velocity to mitral annular velocity (E/e'), whereas LV global longitudinal strain (GLS), circumferential strain, apical rotation, and twist were reduced. LV ejection fraction (LVEF) was also lower, but the LV global radial strain (GRS) was not different between the two groups. Most of these abnormalities showed improvement after renal transplantation. Nearly one-third of all patients had at least a 10% improvement in LVEF, and roughly half had a 10% or more improvement in the mitral E/e' ratio and the LV global longitudinal and circumferential strain. CONCLUSION This study shows that renal transplantation results in a significant regression of LV hypertrophy and an improvement in LV myocardial deformation translating into an improvement in the LV systolic and diastolic function. Further larger and long-term studies are needed to identify the predictors and the clinical significance of these changes.
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Affiliation(s)
- Manish Jain
- Department of Nephrology, Medanta- The Medicity, Gurgaon, Haryana, India
| | - Rakesh Bhat
- Department of Nephrology, Medanta- The Medicity, Gurgaon, Haryana, India
| | | | - Ashish Nandwani
- Department of Nephrology, Medanta- The Medicity, Gurgaon, Haryana, India
| | - Dinesh Yadav
- Department of Nephrology, Medanta- The Medicity, Gurgaon, Haryana, India
| | - Pranaw Kumar Jha
- Department of Nephrology, Medanta- The Medicity, Gurgaon, Haryana, India
| | - Shyam Bansal
- Department of Nephrology, Medanta- The Medicity, Gurgaon, Haryana, India
| | - Dinesh Bansal
- Department of Nephrology, Medanta- The Medicity, Gurgaon, Haryana, India
| | - Vijay Kher
- Department of Nephrology, Medanta- The Medicity, Gurgaon, Haryana, India
| | - Manish Bansal
- Department of Cardiology, Medanta- The Medicity, Gurgaon, Haryana, India
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Tian Z, Bergmann K, Kaufeld J, Schmidt-Ott K, Melk A, Schmidt BM. Left Ventricular Hypertrophy After Renal Transplantation: Systematic Review and Meta-analysis. Transplant Direct 2024; 10:e1647. [PMID: 38769973 PMCID: PMC11104731 DOI: 10.1097/txd.0000000000001647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 05/22/2024] Open
Abstract
Background Left ventricular hypertrophy (LVH) in patients with end stage renal disease undergoing renal replacement is linked to an increased risk for cardiovascular diseases. Dialysis does not completely prevent or correct this abnormality, and the evidence for kidney transplantation (KT) varies. This analysis aims to explore the relationship between KT and LVH. Methods MEDLINE and Scopus were systematically searched in October 2023. All cross-sectional and longitudinal studies that fulfilled our inclusion criteria were included. Outcome was left ventricular mass index (LVMI) changes. We conducted a meta-analysis using a random effects model. Meta-regression was applied to examine the LVMI changes dependent on various covariates. Sensitivity analysis was used to handle outlying or influential studies and address publication bias. Results From 7416 records, 46 studies met the inclusion criteria with 4122 included participants in total. Longitudinal studies demonstrated an improvement of LVMI after KT -0.44 g/m2 (-0.60 to -0.28). Blood pressure was identified as a predictor of LVMI change. A younger age at the time of KT and well-controlled anemia were also associated with regression of LVH. In studies longitudinally comparing patients on dialysis and renal transplant recipients, no difference was detected -0.09 g/m2 (-0.33 to 0.16). Meta-regression using changes of systolic blood pressure as a covariate showed an association between higher blood pressure and an increase in LVMI, regardless of the modality of renal replacement treatment. Conclusions In conclusion, our results indicated a potential cardiovascular benefit, defined as the regression of LVH, after KT. This benefit was primarily attributed to improved blood pressure control rather than the transplantation itself.
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Affiliation(s)
- Zhejia Tian
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Kai Bergmann
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Jessica Kaufeld
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Kai Schmidt-Ott
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Anette Melk
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Bernhard M.W. Schmidt
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
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Lukkanalikitkul E, Pussadhamma B, Ahooja A, Ungprasert P, Toparkngam P, Nawapun S, Takong W, Toimamueang U, Anutrakulchai S. Effect and correlation of patent vascular access flow on left ventricular hypertrophy in kidney transplant patients. IJC HEART & VASCULATURE 2022; 40:101048. [PMID: 35586170 PMCID: PMC9108726 DOI: 10.1016/j.ijcha.2022.101048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 04/22/2022] [Accepted: 05/03/2022] [Indexed: 11/30/2022]
Abstract
Background Patency of vascular accesses (VA) is associated with left ventricular hypertrophy (LVH) in kidney transplant recipients (KTR). This level of VA flow (VAF) as related to LVH was assessed and an upward level of VA flow recommended for VA closure determined. This recommendation has not been previously reported. Methods 123 KTR cohort patients were enrolled between August 2016 and December 2017 and their LVH and LV mass index (LVMI) by echocardiography and VAF by Doppler ultrasound were evaluated at baseline and for a 24-month follow-up period. Associations between VAF and LVH were adjusted for other factors. Results Patients with patent VA (55.3%) had significantly greater LVH (47.1 vs. 29.1%, an adjusted odds ratio 2.44, p = 0.03) and LVMI (112.15 ± 34.4 vs. 97.55 ± 23.55 g/m2, p = 0.009) when compared with the non-VA group. A positive correlation between VAF rate and LVM was noted (r = 0.40, p < 0.001). Subgroup analysis revealed the VAF ≥ 900 ml/min had risks of LVH 3.61, and 2.86 times compared with the non-VA group and the VAF < 900 ml/min group. After a 24-month follow up, there was no significantly individual change in LVMI in patients with or without VA except 6 patients who lost their VA patency during follow-up time had a significant reduction of LVMI (120.17 ± 52.13 to 80.89 ± 22.72 g/m2, p = 0.046). Conclusions Patency of VA in post-KT patients was associated with LVH. There was a significant reduction of LMVI after loss of VA patency. Patients with stable kidney graft function should be considered for VA closure especially if VAF is ≥ 900 ml/min.
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Meucci MC, Reinders MEJ, Groeneweg KE, Bezstarosti S, Ajmone Marsan N, Bax JJ, De Fijter JW, Delgado V. Cardiovascular Effects of Autologous Bone Marrow-Derived Mesenchymal Stromal Cell Therapy With Early Tacrolimus Withdrawal in Renal Transplant Recipients: An Analysis of the Randomized TRITON Study. J Am Heart Assoc 2021; 10:e023300. [PMID: 34913362 PMCID: PMC9075245 DOI: 10.1161/jaha.121.023300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background After renal transplantation, there is a need of immunosuppressive regimens that effectively prevent allograft rejection while minimizing cardiovascular complications. This substudy of the TRITON trial evaluated the cardiovascular effects of autologous bone marrow-derived mesenchymal stromal cells (MSCs) in renal transplant recipients. Methods and Results Renal transplant recipients were randomized to MSC therapy, infused at weeks 6 and 7 after transplantation, with withdrawal at week 8 of tacrolimus or standard tacrolimus dose. Fifty-four patients (MSC group=27; control group=27) underwent transthoracic echocardiography at weeks 4 and 24 after transplantation and were included in this substudy. Changes in clinical and echocardiographic variables were compared. The MSC group showed a benefit in blood pressure control, assessed by a significant interaction between changes in diastolic blood pressure and the treatment group (P=0.005), and a higher proportion of patients achieving the predefined blood pressure target of <140/90 mm Hg compared with the control group (59.3% versus 29.6%, P=0.03). A significant reduction in left ventricular mass index was observed in the MSC group, whereas there were no changes in the control group (P=0.002). The proportion of patients with left ventricular hypertrophy decreased at 24 weeks in the MSC group (33.3% versus 70.4%, P=0.006), whereas no changes were noted in the control group (63.0% versus 48.1%, P=0.29). Additionally, MSC therapy prevented progressive left ventricular diastolic dysfunction, as demonstrated by changes in mitral deceleration time and tricuspid regurgitant jet velocity. Conclusions MSC strategy is associated with improved blood pressure control, regression of left ventricular hypertrophy, and prevention of progressive diastolic dysfunction at 24 weeks after transplantation. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03398681.
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Affiliation(s)
- Maria Chiara Meucci
- Department of Cardiology Leiden University Medical Center Leiden the Netherlands.,Department of Cardiovascular and Thoracic Sciences Fondazione Policlinico Universitario A. Gemelli IRCCSCatholic University of the Sacred Heart Rome Italy
| | - Marlies E J Reinders
- Department of Internal Medicine (Nephrology) Leiden University Medical Center Leiden the Netherlands
| | - Koen E Groeneweg
- Department of Internal Medicine (Nephrology) Leiden University Medical Center Leiden the Netherlands
| | - Suzanne Bezstarosti
- Department of Internal Medicine (Nephrology) Leiden University Medical Center Leiden the Netherlands.,Department of Immunology Leiden University Medical Center Leiden the Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology Leiden University Medical Center Leiden the Netherlands
| | - Jeroen J Bax
- Department of Cardiology Leiden University Medical Center Leiden the Netherlands.,Heart Center University of Turku and Turku University Hospital Turku Finland
| | - Johan W De Fijter
- Department of Internal Medicine (Nephrology) Leiden University Medical Center Leiden the Netherlands
| | - Victoria Delgado
- Department of Cardiology Leiden University Medical Center Leiden the Netherlands
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Kalra DK, Madan N. Defined by the Company One Keeps: The Importance of Cardiac Comorbidities after Kidney Transplant Cardiac Remodeling and Outcomes. Cardiology 2020; 145:77-79. [PMID: 31914440 DOI: 10.1159/000505203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 12/02/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Dinesh K Kalra
- Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA,
| | - Nidhi Madan
- Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
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Lakkas L, Naka KK, Bechlioulis A, Girdis I, Duni A, Koutlas V, Moustakli M, Katsouras CS, Dounousi E, Michalis LK. The prognostic role of myocardial strain indices and dipyridamole stress test in renal transplantation patients. Echocardiography 2019; 37:62-70. [PMID: 31872917 DOI: 10.1111/echo.14570] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/16/2019] [Accepted: 12/04/2019] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Renal transplantation (RT) increases survival in end-stage kidney disease patients but cardiovascular diseases remain the leading cause of morbidity and mortality. We evaluated the role of myocardial strain (2DSTE) indices and dipyridamole-induced (DIPSE) changes in echocardiographic parameters at baseline for the prediction of clinical events and echocardiographically assessed deterioration of cardiac function in a RT population. METHODS Forty-five RT patients underwent an echocardiographic study at baseline including 2DSTE and DIPSE. If no cardiovascular/renal event occurred, patients were investigated at 3-year follow-up; eight patients presented a clinical event while 37 patients were re-evaluated. RESULTS Coronary flow reserve (CFR) was abnormal in 24% of the population. DIPSE induced improvements in classic and 2DSTE systolic and diastolic echocardiographic indices including TWIST, UNTWIST, global longitudinal strain (GLS), and circumferential strain (P < .05 for all). Compared to baseline, deteriorations in E/E', LVEF, E', and TWIST were observed at follow-up (P < .05 for all). DIPSE-induced changes in GLS, global radial strain, and LVEF were associated with changes in these indices at follow-up (P < .05 for all). Higher LV mass index, E/E', and lower MAPSE, E', and CFR at baseline were associated with the occurrence of clinical events at follow-up (P < .05 for all). CONCLUSIONS In RT patients, coronary vascular dysfunction (ie, low CFR) was associated with the occurrence of adverse events. DIPSE-induced changes in myocardial strain and classic echocardiographic indices could identify individuals with a subclinical deterioration in cardiac function at follow-up. This may indicate that DIPSE could serve as a means to assess myocardial reserve in this population.
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Affiliation(s)
- Lampros Lakkas
- Second Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Katerina K Naka
- Second Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Aris Bechlioulis
- Second Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Ioannis Girdis
- Second Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Anila Duni
- Renal Transplant Unit, University Hospital of Ioannina, Ioannina, Greece
| | - Vasileios Koutlas
- Renal Transplant Unit, University Hospital of Ioannina, Ioannina, Greece
| | - Maria Moustakli
- Second Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Christos S Katsouras
- Second Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Evangelia Dounousi
- Renal Transplant Unit, University Hospital of Ioannina, Ioannina, Greece
| | - Lampros K Michalis
- Second Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece
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Cardiovascular Parameters to 2 years After Kidney Transplantation Following Early Switch to Everolimus Without Calcineurin Inhibitor Therapy: An Analysis of the Randomized ELEVATE Study. Transplantation 2017; 101:2612-2620. [PMID: 28333860 DOI: 10.1097/tp.0000000000001739] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Mammalian target of rapamycin inhibitors may confer cardioprotective advantages, but clinical data are limited. METHODS In the open-label ELEVATE trial, kidney transplant patients were randomized at 10 to 14 weeks after transplant to convert from calcineurin inhibitor (CNI) to everolimus or remain on standard CNI therapy. Prespecified end points included left ventricular mass index and, in a subpopulation of patients, arterial stiffness as measured by pulse wave velocity. RESULTS The mean change in left ventricular mass index from randomization was similar with everolimus versus CNI (month 24, -4.37 g/m versus -5.26 g/m; mean difference, 0.89 [p = 0.392]). At month 24, left ventricular hypertrophy was present in 41.7% versus 37.7% of everolimus and CNI patients, respectively. Mean pulse wave velocity remained stable with both everolimus (mean change from randomization to month 12, -0.24 m/s; month 24, -0.03 m/s) and CNI (month 12, 0.11 m/s; month 24, 0.16 m/s). The change in mean ambulatory nighttime blood pressure from randomization showed a benefit for diastolic pressure at month 12 (P = 0.039) but not at month 24. Major adverse cardiac events occurred in 1.1% and 4.2% of everolimus-treated and CNI-treated patients, respectively, by month 12 (P = 0.018) and 2.3% (8/353) and 4.5% by month 24 (P = 0.145). CONCLUSIONS Overall, these data do not suggest a clinically relevant effect on cardiac end points after early conversion from CNI to a CNI-free everolimus-based regimen.
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Longitudinal assessment of myocardial function in childhood chronic kidney disease, during dialysis, and following kidney transplantation. Pediatr Nephrol 2017; 32:1401-1410. [PMID: 28275864 DOI: 10.1007/s00467-017-3622-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 01/22/2017] [Accepted: 01/23/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Childhood chronic kidney disease (CKD) and dialysis are associated with increased long-term cardiovascular risk. We examined subclinical alterations in myocardial mechanics longitudinally in children with CKD, during dialysis, and following renal transplantation. METHODS Forty-eight children with CKD (stage III or higher) who received kidney transplants from 2008 to 2014 were included in a retrospective study and compared to 192 age- and sex-matched healthy children. Measurements of cardiac systolic and diastolic function were performed, and global longitudinal strain (GLS) and circumferential strain (GCS) were measured by speckle-tracking echocardiography at CKD, during dialysis, and 1 year following kidney transplantation. Mixed-effects modeling examined changes in GLS and GCS over different disease stages. RESULTS Children with CKD had a mean age of 10 ± 5 years and 67% were male. Eighteen children received preemptive transplantation. Children with CKD had increased left ventricular mass, lower GLS, and impaired diastolic function (lower E/A ratio and E' velocities) than healthy children. Changes in left ventricular diastolic parameters persisted during dialysis and after renal transplantation. Dialysis was associated with reduced GLS compared to CKD (β = 1.6, 95% confidence interval 0.2-3.0); however, this was not significant after adjustment for systolic blood pressure and CKD duration. Post-transplantation GLS levels were similar to those at CKD assessment. GCS was unchanged during dialysis but significantly improved following transplantation. CONCLUSIONS There are differences in diastolic parameters in childhood CKD that persist during dialysis and after transplantation. Systolic parameters are preserved, with significant improvement in systolic myocardial deformation following transplantation. The impact of persistent diastolic changes on long-term outcomes requires further investigation.
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Anastasopoulos NA, Dounousi E, Papachristou E, Pappas C, Leontaridou E, Savvidaki E, Goumenos D, Mitsis M. Cardiovascular disease: Risk factors and applicability of a risk model in a Greek cohort of renal transplant recipients. World J Transplant 2017; 7:49-56. [PMID: 28280695 PMCID: PMC5324028 DOI: 10.5500/wjt.v7.i1.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/17/2016] [Accepted: 01/03/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To investigate the incidence and the determinants of cardiovascular morbidity in Greek renal transplant recipients (RTRs) expressed as major advance cardiac event (MACE) rate.
METHODS Two hundred and forty-two adult patients with a functioning graft for at least three months and available data that were followed up on the August 31, 2015 at two transplant centers of Western Greece were included in this study. Baseline recipients’ data elements included demographics, clinical characteristics, history of comorbid conditions and laboratory parameters. Follow-up data regarding MACE occurrence were collected retrospectively from the patients’ records and MACE risk score was calculated for each patient.
RESULTS The mean age was 53 years (63.6% males) and 47 patients (19.4%) had a pre-existing cardiovascular disease (CVD) before transplantation. The mean estimated glomerular filtration rate was 52 ± 17 mL/min per 1.73 m2. During follow-up 36 patients (14.9%) suffered a MACE with a median time to MACE 5 years (interquartile range: 2.2-10 years). Recipients with a MACE compared to recipients without a MACE had a significantly higher mean age (59 years vs 52 years, P < 0.001) and a higher prevalence of pre-existing CVD (44.4% vs 15%, P < 0.001). The 7-year predicted mean risk for MACE was 14.6% ± 12.5% overall. In RTRs who experienced a MACE, the predicted risk was 22.3% ± 17.1% and was significantly higher than in RTRs without an event 13.3% ± 11.1% (P = 0.003). The discrimination ability of the model in the Greek database of RTRs was good with an area under the receiver operating characteristics curve of 0.68 (95%CI: 0.58-0.78).
CONCLUSION In this Greek cohort of RTRs, MACE occurred in 14.9% of the patients, pre-existing CVD was the main risk factor, while MACE risk model was proved a dependable utility in predicting CVD post RT.
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