Multiple Heart Abnormalities Predict CV Death in Kidney Transplant Patients

Jim Kling

May 05, 2010

May 5, 2010 (San Diego, California) — In patients with end-stage renal disease (ESRD) undergoing kidney transplant, the presence of 2 or more cardiovascular abnormalities is a predictor of lower cardiovascular survival. The results were presented here at the American Transplant Congress 2010.

ESRD patients are at heightened risk for premature cardiovascular death, which is associated with uremic cardiomyopathy (including left ventricular [LV] hypertrophy [LVH], LV systolic dysfunction [LVSD], and LV dilation). These abnormalities are often found in combination. The researchers employed cardiovascular magnetic resonance imaging (CMR) to assess myocardial structure in 446 ESRD patients, and patient outcomes were obtained over a 7.6-year follow-up period. In all, 336 patients were placed on renal transplant wait lists, and 114 received transplants.

CMR revealed that 156 patients (35.0%) had normal heart architecture, 276 (61.9%) had LVH, 85 (19.0%) had LVSD, and 62 (13.9%) had LV dilation. A single abnormality was found in 94 patients (43.5%), whereas 97 patients (21.7%) had 2 or 3 abnormalities. Death occurred in 95 patients (18 after transplantation), and 53 of these were due to cardiovascular causes (6 after transplantation).

Each abnormality was evaluated. Analysis revealed that patients with 2 or 3 abnormalities had significantly lower cardiovascular survival (P < .01).

"In patients being assessed for renal transplantation, LVH, LVSD, and LV dilation are associated with poorer [cardiovascular] survival. Accumulation of cardiac abnormalities is also associated with a significantly poorer [cardiovascular] prognosis," the authors report in their abstract.

"One abnormality does not significantly affect survival, but the presence of 2 or more abnormalities is associated with a significantly poorer prognosis," Rajan Patel, MBChB, said during his presentation. Dr. Patel is a clinical lecturer in nephrology and transplantation at the University of Glasgow in Scotland.

The results corroborate existing information. "I don't think the overall results were surprising," Joseph Kim, MD, PhD, a transplant nephrologist at Toronto General Hospital in Ontario, told Medscape Transplantation.

Dr. Kim would like to see more longitudinal studies using CMR to see how cardiac architecture changes over time. "So many studies do a single snapshot, and that's not realistic," he said.

Ultimately, the use of CMR could be dictated by cost. "If it becomes affordable, it would be another piece of our diagnostic armament," said Dr. Kim.

The study did not receive commercial support. Dr. Patel and Dr. Kim have disclosed no relevant financial relationships.

American Transplant Congress (ATC) 2010: Abstract 52. Presented May 2, 2010.

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