Renal Transplantation Is Not Associated with Regression of Left Ventricular Hypertrophy: A Magnetic Resonance Study

Background and objectives: Patients with end-stage renal failure (ESRD) have an increased risk of premature cardiovascular (CV) disease. Left ventricular hypertrophy is an independent risk factor for CV events and death in ESRD. Renal transplantation has been associated with reduction in CV risk and echocardiographic regression of left ventricular hypertrophy. However, echocardiography overestimates LV mass in ESRD patients. Cardiac magnetic resonance (CMR) provides more detailed, volume-independent, measures of cardiac structure. Changes in LV mass measured by CMR after renal transplantation were studied.Design, setting, participants, & measurements: Fifty patients underwent CMR on two occasions. Twenty-five were transplanted before the second scan. CMR was performed to measure LV mass index (LVMI), ejection fraction, end-diastolic and end-systolic volumes. Changes were expressed as percentage change over time. Patients with CV events between scans (e.g., acute coronary syndrome, myocardial infarction) were excluded. All transplant patients had serum creatinine <150 μmol/L.Results: There was no significant change in LVMI between patients who underwent renal transplantation and those who remained on dialysis (transplanted mean, 2.75%/yr, ± 9.1 versus dialysis, −3.6%/yr ± 16.7). In addition, there were no significant changes in end-diastolic volume (transplant, 0.1%/yr ± 19.5 versus not transplanted, −3.4%/yr ± 31.5), end-systolic volume (transplanted mean, 15.2%/yr ± 65.2 versus not transplanted, 3.0%/yr ± 55.5), or ejection fraction (transplant, 2.1%/yr ± 11.9 versus not transplanted, −0.4%/yr ± 5.3).Conclusions: Renal transplantation is not associated with significant regression of LVMI on CMR compared with patients who remain on the transplant waiting list.Patients with end-stage renal disease (ESRD), particularly those requiring dialysis and transplantation, have an increased risk of premature cardiovascular disease (CVD; (1)). Left ventricular hypertrophy (LVH) is a common feature of patients with ESRD, a component of uremic cardiomyopathy, and an independent risk factor for sudden cardiac death, heart failure, and cardiac arrhythmias in the general population and dialysis patients (2,3). Furthermore, successful renal transplantation (RT) is associated with lower cardiovascular morbidity and mortality compared with patients who remain on the transplant waiting list (4) and has been reportedly associated with significant echocardiographic regression of LVH (5,6).However, accurate echocardiographic estimation of left ventricular (LV) mass in ESRD patients is difficult because of large variation in intravascular (and hence intraventricular) volume during the interdialytic period and during dialysis therapy (7). Furthermore, geometric assumptions made during calculation of LV mass from conventional M mode echocardiography dimensions (8) result in greater inaccuracies because of geometric LV distortion in patients with LVH and ESRD (representing the majority of patients).Cardiac magnetic resonance (CMR) provides more detailed, volume-independent, measurement of cardiac structure and is considered the ′gold standard′ for assessing ventricular dimensions in patients, including those with stage 5 chronic kidney disease (9–11).The aim of this study was to compare changes in LV structure and function between patients that had undergone RT and those that remained on the transplant waiting list.