Korean J Transplant.  2022 Nov;36(Supple 1):S193. 10.4285/ATW2022.F-3272.

Impact of the longitudinal changes of myocardial remodeling on kidney transplantation outcomes

• Kim MG
• Gwon JG
• Cho DH
• Choi J
• Jung CW
• Jun H

• KMID: 2535709
• DOI: http://doi.org/10.4285/ATW2022.F-3272

Abstract

Background
Kidney transplantation (KT) improves the hemodynamic burden associated with volume overload, and anemia in patients with chronic kidney disease, but cardiovascular disease remains the leading cause of death after KT. This study evaluated the longitudinal change of eccentric and concentric myocardial remodeling and its impact on cardiovascular outcomes after KT.
Methods
A total of 600 patients who underwent echocardiography before and 3 years after KT were included from a multicenter observational cohort (KNOW-KT). Conventional echocardiograph evaluated left ventricular ejection fraction (LVEF), LV mass index (LVMI) LV end-diastolic dimension (LVEDD), and relative wall thickness (RWT) at baseline and after KT, and the changes of these parameters and their effect on the cardiovascular events were investigated.
Results
After KT, LV EF, LVMI, and the myocardial eccentricity represented by LVEDD were significantly improved during 3 years (LVEF, 61.4±7.9%–64.8±6.0%; LVMI, 113.4±31.8–94.4±23.4 g/m ² ; LVEDD, 51.2±5.6–47.1±4.8 mm), however, the myocardial con-centricity represented by RWT were increased from 0.39±0.07 to 0.41±0.07. In the correlation analysis between the change of echocardiographic and clinical parameters, the change of LVEDD was associated with change of hemodynamic stress such as hemoglobin or systolic blood pressure, whereas the change of RWT showed significant association with change of metabolic stress such as HbA1c and triglycerides. There were 30 major adverse cardiovascular events (MACE, myocardial infarction, an-gina or strokes) after KT, and the incidence of MACE significantly increased in patients with the increased RWT group, but not in the increased LVEDD group after KT. In particular, in multivariate analysis corrected for baseline echo value, age, sex, diabetes, etc., an increase in RWT, independently predicted the occurrence of MACE (hazard ratio, 2.20; confidence interval, 1.21–3.99; P<0.01), but other echocardiographic parameters including LVEF, LVMI, and LVEDD did not.
Conclusions
Longitudinal changes in myocardial concentricity is associated with the metabolic stress and have a significant impact on the new onset cardiovascular disease in KT patients. Improving metabolic burden after KT should be considered as an important strategy for amelioration of cardiac remodeling and adverse event.