Oncotarget. 2017;8(41):71154-71163.

The prognostic significance of preoperative left ventricular diastolic dysfunction and left atrial enlargement on acute coronary syndrome in kidney transplantation.

, , , , , , , , , ,

제1저자 황진호 · 교신저자 이정표

PMID 29050351 PMC5642626 DOI 10.18632/oncotarget.16862 IF 5.168 신장내과

소속 (8)

Nephrology Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea.
Cardiology Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Nephrology Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.
Department of Critical Care Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.
Transplantation Center, Seoul National University Hospital, Seoul, Korea.
Nephrology Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Department of Surgery, Seoul National University Boramae Medical Center, Seoul, Korea.
Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea.

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.

Keywords

acute coronary syndromecardiovascular diseasekidney transplantationrenal transplantationtransthoracic echocardiography

Figures

**Figure 1** Kaplan–Meier curves for posttransplant occurrence of ACS and all-cause mortality in the LVDD grade–based group (**A, B**) Patients with LVDD grades 2–3 showed worse ACS outcomes than the patient group with LVDD grades 0–1 (P = 0.005 for non-fatal, P = 0.02 for fatal/non-fatal ACS). (C) All-cause mortality did not differ between the two groups (P = 0.50).

**Figure 2** Kaplan–Meier curves for post-KT occurrence of ACS and all-cause mortality in the LA size–based group (**A, B**) Patients with larger LA size showed worse ACS outcomes than patients with smaller LA size (P = 0.001 for non-fatal, P = 0.03 for fatal/non-fatal ACS). (C) All-cause mortality did not differ between the two groups (P = 0.50).

**Figure 3** Kaplan–Meier curve for all-cause mortality by non-fatal ACS after KT (P < 0.001)

**Figure 4** Kaplan–Meier curves for post-KT occurrence of ACS, GF, and all-cause mortality in the LVDD grade– and median LA size based groups (**A, B**) In patients who had both LVDD grades 2–3 and LAE, ACS occurred significantly more often than in patients who were diagnosed with LVDD or LAE alone (P = 0.001 for non-fatal ACS, P = 0.01 for fatal/non-fatal ACS). (C) Results for all-cause mortality were statistically insignificant overall (P = 0.62).

그림 출처: PubMed Central 공개 논문 (PMC5642626)

Conflict of interest statement

CONFLICTS OF INTEREST None declared.

그 밖의 정보