Clinical Research Papers:
The prognostic significance of preoperative left ventricular diastolic dysfunction and left atrial enlargement on acute coronary syndrome in kidney transplantation
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Abstract
Jin Ho Hwang1, Jun-Bean Park2, Yong-Jin Kim2, Jung Nam An3,4, Jaeseok Yang5, Curie Ahn5,6, In Mok Jung7, Chun Soo Lim3, Yon Su Kim6, Young Hoon Kim8 and Jung Pyo Lee3,6
1Nephrology Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
2Cardiology Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
3Nephrology Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
4Department of Critical Care Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
5Transplantation Center, Seoul National University Hospital, Seoul, Korea
6Nephrology Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
7Department of Surgery, Seoul National University Boramae Medical Center, Seoul, Korea
8Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea
Correspondence to:
Jung Pyo Lee, email: [email protected]
Young Hoon Kim, email: [email protected]
Keywords: acute coronary syndrome, cardiovascular disease, transthoracic echocardiography, kidney transplantation, renal transplantation
Received: February 08, 2017 Accepted: March 28, 2017 Published: April 05, 2017
ABSTRACT
Echocardiography is commonly performed as a screening test to evaluate perioperative risks before kidney transplantation. However, only limited data are available on echocardiographic parameters of left ventricular diastolic dysfunction (LVDD) and left atrial enlargement (LAE) on acute coronary syndrome and mortality in kidney transplant recipients. We reviewed 2779 adult recipients who underwent pretransplant echocardiography from 1997 to 2012. We divided the patients into two and four groups by two categories: LVDD grades 0–1 vs. 2–3, and left atrial size quartile groups. During a mean follow-up of 4.5 years, acute coronary syndrome occurred in 89 (3.2%) patients. The recipients with LVDD grades 2–3 (P = 0.005 for non-fatal, P = 0.02 for fatal/non-fatal) and LAE (P = 0.001 for non-fatal, P = 0.03 for fatal/non-fatal) had a higher incidence of acute coronary syndrome after kidney transplantation. All-cause mortality did not differ significantly between the groups. In a multivariate analysis, LVDD of grades 2–3 (hazard ratio 2.98, 95% confidence interval 1.535–5.787; P = 0.001), and LAE (hazard ratio 1.052, 95% confidence interval 1.006–1.101; P = 0.03) were independently associated with non-fatal acute coronary syndrome. In patients who are kidney transplant candidates, pretransplant LVDD and LAE were independently associated with a higher incidence of acute coronary syndrome after kidney transplantation.
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