Reversal of left ventricular dysfunction after renal transplantation.
We report the cases of four patients with end-stage renal disease and New York Heart Association class III or IV heart failure of nonischemic origin as documented by coronary angiography. Because of left ventricular dysfunction (left ventricular end-diastolic pressure, 23 to 30 mm Hg; ejection fraction, 20% to 35%), all four patients were initially considered poor surgical candidates for renal transplantation. These same four patients became asymptomatic, however, with markedly improved cardiac function (ejection fraction, 43% to 69%) detected as early as 6 and 14 days after renal engraftment. Therefore, there exists a subset of patients with end-stage renal disease in whom congestive heart failure should not be considered a contraindication to renal transplantation. We conclude that some dialysis-dependent patients who manifest symptomatic heart failure of nonischemic origin have a reversible cardiomyopathy and should not be denied renal transplantation.
Burt
R K
RK
St. Luke's Episcopal Hospital, Houston, Texas.
Gupta-Burt
S
S
Suki
W N
WN
Barcenas
C G
CG
Ferguson
J J
JJ
Van Buren
C T
CT
D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000503:physiopathology*; D017023:Coronary Angiography; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery*; D016030:Kidney Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods; D013318:Stroke Volume / Q000502:physiology