NDT Advance Access originally published online on April 23, 2007
Nephrology Dialysis Transplantation 2007 22(8):2328-2333; doi:10.1093/ndt/gfm110
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Reduced coronary flow reserve in young adults with renal transplant
1Chair and Graduate School of Nephrology, Department of Sciences and Biomedical Technologies University of Milano, 20090 Segrate (MI), 2Pediatric Nephrology Unit, IRCCS Maggiore Hospital, Mangiagalli and Regina Elena Foundation, 20122, 3Hypertension and Preventive Nephrology Unit, IRCCS Multimedica, 20099, Sesto San Giovanni (MI) 4Cardiology Unit, IRCCS Istituto Ortopedico Galeazzi, 20161, 5Department of Clinical Sciences L. Sacco, University of Milano, 20157 and 6Epidemology Unit, Department of Occupational and Environmental Health, IRCCS Maggiore Hospital, Mangiagalli and Regina Elena Foundation, 20122, Milano, Italy
Correspondence and offprint requests to: S. M. Viganò, Chair and Graduate School of Nephrology, Department of Sciences and Biomedical Technologies, University of Milano, Via Fratelli Cervi 93, 20090 Segrate (MI), Italy. Email: saramaria.vigano{at}studenti.unimi.it
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Abstract |
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Background. Some degree of cardiovascular disease should be suspected in young adults who have been paediatric renal transplant recipients also if no systematic data collection is routinely performed in clinical setting. The aim of our work was to evaluate the degree of cardiovascular damage in these young patients, using a minimally invasive technique. We then evaluated coronary flow reserve (CFR) and carotid intima-media thickness (IMT) in 25 patients (13 males, median age 23.7 years).
Methods. Coronary flow velocity on the left anterior descending coronary artery was assessed by transthoracic echocardiography, before and after dipyridamole, after standard echocardiography. CFR was compared with that of a small control group (n = 16; median age 25 yrs).
Results. In this relatively young sample, mean CFR was 2.8 ± 0.6 (median 2.75), and half of the patients had reduced coronary reserve (P = 0.01). Mean IMT (0.48 ± 0.08 mm) was only slightly, though significantly larger compared with the reference standard (P < 0.05) but was significantly thinner in normotensive than in hypertensive patients (0.42 ± 0.06 vs 0.49 ± 0.05 mm, P < 0.05). The time on dialysis prior to transplantation, hypertension and age at the time of CFR evaluation affect CFR. IMT did not correlate with CFR.
Conclusions: CFR and IMT abnormalities are common in young transplant recipients, in spite of the fact that our paediatric population has much less of the atherosclerotic ‘legacy’ common to adult patients.
Keywords: paediatrics; kidney transplantation; cardiovascular risk; stress echography
Received for publication: 9.11.06
Accepted in revised form: 8. 2.07