Reduced global longitudinal strain is associated with increased risk of cardiovascular events or death after kidney transplant. (1st December 2018)

• Record Type: Journal Article
• Authors: Fujikura, Kana; Peltzer, Bradley; Tiwari, Nidhish; Shim, Hye Gi; Dinhofer, Ally B.; Shitole, Sanyog G.; Kizer, Jorge R.; Garcia, Mario J.
• Is Part Of: International journal of cardiology. Volume 272(2018)
• Page Start: 323
• Page End: 328
• Publication Date: 2018-12-01
• Subjects: Echocardiogram -- Speckle-tracking -- Global longitudinal strain -- Kidney transplant -- Post-transplant events; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2018.07.088
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Patients with chronic kidney disease are at increased risk of cardiovascular disease (CVD). Even after kidney transplant, the rate of CVD events and death remain elevated. Early detection of patients at risk would be helpful for guiding aggressive preventive therapy. The purpose of this study was to evaluate global longitudinal strain (GLS) as a predictor of CVD events and death after kidney transplant. Method: Among patients with successful kidney transplant between 3/2009 and 12/2012 at our institution, 111 individuals had an echocardiogram within 6 months of the transplant. Medical records were evaluated for demographics and patient characteristics. Echocardiograms were analyzed for conventional measurements, and GLS was assessed using speckle-tracking analysis. Results: The median age of the study sample was 54 years. Overall, 60% were men; 35% were non-Hispanic black, and 50% Hispanic. After a mean follow-up of 3.8 ± 0.5 years, there were 21 cardiovascular events or deaths. Patients who experienced an event were older, more frequently had a history of coronary artery disease, and had higher LV filling/longitudinal diastolic annular velocity (E/e') than those who did not. GLS was significantly associated with event-free survival even after adjusting for age, sex, race-ethnicity, hypertension, diabetes, history of coronary artery disease or heart failure, and E/e'. Conclusion: Reduced GLS peri-transplant is significantly associated with increased CVD events or death after kidney transplant. Larger studies are required to determine the incremental predictive value of GLS over clinical and other echocardiographic parameters for adverse CVD events following renal transplantation. Highlights: CKD has long been identified as a risk factor for CVD. Even after kidney transplant, the rate of CVD events and death remain elevated. GLS identifies LV dysfunction even in the context of normal LV ejection fraction in various diseases. GLS peri-transplant proved to be independently associated with CVD events and death. GLS may be an important screening tool to stratify the risk of patients undergoing kidney transplant.