title: Echocardiography predicts major adverse cardiovascular events after renal transplantation.
abstract: BACKGROUND
  Cardiovascular disease is a leading cause of morbidity and mortality after renal transplantation. We analysed whether pre-transplant transthoracic echocardiograms (TTE) predicted major adverse cardiovascular events (MACE) after transplant.
  
  
  METHODS
  We retrospectively analysed clinical and TTE data from patients having renal transplantation at a single centre between 1 January 2000 and 31 December 2010. The TTE were classified as: group A - normal; group B - mild abnormalities expected in renal failure; group C - moderate to severe abnormalities likely to change management. They were also scored based on four independent risk factors [age ≥50, left ventricular (LV) end systolic diameter ≥3.5 cm, LV wall thickness ≥1.4 cm and mitral annulus calcification]. Post-transplantation clinical notes were examined for MACE (death, stroke, myocardial infarction, and surgical or percutaneous revascularisation).
  
  
  RESULTS
  There were 343 patients, mean age 47 (range 21-83) years, 210 of whom were male. MACE occurred in 29 (8.5%) at a mean of 3.6 (SD 3.3) years after transplantation. They were older (p ≤ 0.001), had larger LV mass (p = 0.02), LV wall thickness (p = 0.008) and left atrial size (p = 0.001) than those without MACE. The MACE rate for groups A, B and C were 1.8, 13.6 and 16.4% (p ≤ 0.001), respectively. Using the score, the risk of MACE was 4.7, 10.7, 9.2 and 40% for scores 0, 1, 2 and 3 (p = 0.023), respectively.
  
  
  CONCLUSIONS
  Preoperative transthoracic echocardiography identifies patients at risk of death or non-fatal cardiovascular events even late after renal transplantation. This suggests that echocardiography might be useful to identify patients requiring more aggressive long-term treatment of modifiable vascular risk factors.
authors.affiliation: Adult Echocardiography Cardiothoracic Centre and Department of Renal Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Haotian
authors.initials: H
authors.lastname: Gu
authors.forename: Majid
authors.initials: M
authors.lastname: Akhtar
authors.forename: Amit
authors.initials: A
authors.lastname: Shah
authors.forename: Anjalika
authors.initials: A
authors.lastname: Mallick
authors.forename: Marlies
authors.initials: M
authors.lastname: Ostermann
authors.forename: John
authors.initials: J
authors.lastname: Chambers
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004452:Echocardiography; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D057234:Preoperative Period; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D020521:Stroke / Q000453:epidemiology*; D055815:Young Adult