title: Pre-operative echocardiographic abnormalities and adverse outcome following renal transplantation.
abstract: 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.
authors.affiliation: Renal Unit, Western Infirmary, Glasgow, UK.
authors.forename: E
authors.initials: E
authors.lastname: McGregor
authors.forename: A G
authors.initials: AG
authors.lastname: Jardine
authors.forename: L S
authors.initials: LS
authors.lastname: Murray
authors.forename: H J
authors.initials: HJ
authors.lastname: Dargie
authors.forename: R S
authors.initials: RS
authors.lastname: Rodger
authors.forename: B J
authors.initials: BJ
authors.lastname: Junor
authors.forename: M A
authors.initials: MA
authors.lastname: McMillan
authors.forename: J D
authors.initials: JD
authors.lastname: Briggs
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000503:physiopathology; D015331:Cohort Studies; D004452:Echocardiography; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D016019:Survival Analysis; D016277:Ventricular Function, Left