Renal transplantation is not associated with regression of left ventricular hypertrophy: a magnetic resonance study.
OBJECTIVE
Patients with end-stage renal failure (ESRD) have an increased risk of premature cardiovascular (CV) disease. Left ventricular hypertrophy is an independent risk factor for CV events and death in ESRD. Renal transplantation has been associated with reduction in CV risk and echocardiographic regression of left ventricular hypertrophy. However, echocardiography overestimates LV mass in ESRD patients. Cardiac magnetic resonance (CMR) provides more detailed, volume-independent, measures of cardiac structure. Changes in LV mass measured by CMR after renal transplantation were studied.


METHODS
Fifty patients underwent CMR on two occasions. Twenty-five were transplanted before the second scan. CMR was performed to measure LV mass index (LVMI), ejection fraction, end-diastolic and end-systolic volumes. Changes were expressed as percentage change over time. Patients with CV events between scans (e.g., acute coronary syndrome, myocardial infarction) were excluded. All transplant patients had serum creatinine <150 mumol/L.


RESULTS
There was no significant change in LVMI between patients who underwent renal transplantation and those who remained on dialysis (transplanted mean, 2.75%/yr, +/- 9.1 versus dialysis, -3.6%/yr +/- 16.7). In addition, there were no significant changes in end-diastolic volume (transplant, 0.1%/yr +/- 19.5 versus not transplanted, -3.4%/yr +/- 31.5), end-systolic volume (transplanted mean, 15.2%/yr +/- 65.2 versus not transplanted, 3.0%/yr +/- 55.5), or ejection fraction (transplant, 2.1%/yr +/- 11.9 versus not transplanted, -0.4%/yr +/- 5.3).


CONCLUSIONS
Renal transplantation is not associated with significant regression of LVMI on CMR compared with patients who remain on the transplant waiting list.
Patel
Rajan K
RK
BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
Mark
Patrick B
PB
Johnston
Nicola
N
McGregor
Ellon
E
Dargie
Henry J
HJ
Jardine
Alan G
AG
D000328:Adult; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016030:Kidney Transplantation; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D014850:Waiting Lists