Nephrology Dialysis Transplantation, Vol 13, Issue 6 1499-1505, Copyright © 1998 by Oxford University Press
E McGregor, A Jardine, L Murray, H Dargie, R Rodger, B Junor, M McMillan and J Briggs
Background: Premature cardiovascular disease is now
the leading cause of death in renal transplant recipients. Although
patients with progressive renal disease have many of the conventional risk
factors for cardiovascular disease these do not have the same predictive
power as they do in the general population. Echocardiographic
abnormalities, notably left ventricular hypertrophy, have been shown to be
associated with adverse outcome in patients on dialysis.
Methods: The echocardiograms were studied from 141
patients who were examined on the eve of renal transplantation between 1988
and 1990 to try to identify factors predicting outcome. Thirty-four
patients have since died, 22 of cardiovascular disease. Ninety-three of the
survivors and 27 of the dead patients had echocardiographic traces suitable
for analysis. Results: Left ventricular mass index was
increased in those patients who died (median 167 vs
134 g/m2; P=0.03), as were end-systolic (4.3
vs 3.4 cm; P<0.01) and end-diastolic (5.8
vs 5.2 cm; P<0.01) diameters. Systolic function
was also more severely impaired (fractional shortening, 27
vs 33%; P<0.01). Apart from age, only systolic
function and end systolic diameter were independent predictors of outcome
in multivariate analysis. Conclusions: This pattern of
echocardiographic abnormality is similar to that reported in long-term
dialysis populations, despite the adverse effects on survival. Moreover,
despite potential benefits of transplantation on cardiac function, left
ventricular hypertrophy, ventricular dilatation and systolic dysfunction
were all associated with adverse outcome following transplantation. We
conclude that echocardiography identifies markers for premature death
following transplantation and provides targets for therapeutic
intervention. Key words: echocardiography; left
ventricular hypertrophy; renal transplantation; survival
ORIGINAL ARTICLES
Pre-operative echocardiographic abnormalities and adverse outcome following renal transplantation
Renal Unit, Departments of Medicine and Therapeutics and Cardiology, University of Glasgow, Gardiner Institute, Western Infirmary, Glasgow G11 6NT, UK; Corresponding author
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