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Improvement in right heart function following kidney transplantation in esrd patients: insights from speckle tracking echocardiography analysis

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Abstract

Chronic kidney disease (CKD) is commonly associated with unfavorable cardiovascular outcomes and remains the leading cause of mortality in individuals with end-stage renal disease (ESRD). Despite substantial knowledge about the impact of CKD on the left heart, the right heart, which holds significant clinical relevance, has often been overlooked and inadequately assessed in ESRD patients who have undergone kidney transplant (KTx). This study aimed to evaluate the effects of KTx on the right heart chambers in ESRD patients. 57 adult KTx candidates were enrolled in this prospective longitudinal study, while 49 of them were included in the final assessment. Patients underwent a comprehensive cardiac assessment, including conventional echocardiography, speckle tracking echocardiography, and three-dimensional heart modeling both before and after surgery. Echocardiographic assessments showed significant increases in right ventricular (RV) ejection fraction, RV fractional area change (RVFAC), tricuspid annular plain systolic excursion, RV fractional shortening, right atrial (RA) reservoir, conduit, and booster strains, and RV global longitudinal strain (RVGLS). Moreover, significant reductions in RV end-diastolic volume (RVEDV), RV end-systolic volume (RVESV), RV stroke volume, RV end-diastolic diameter (RVEDD) in mid-cavity view, systolic pulmonary artery pressure was observed (all P values < 0.05). However, no significant difference was found in S velocity, as well as RVEDD in basal and apex-to-annulus view. Moreover, pre-KTx measurements of RVGLS, RVEDD (apex-to-annulus diameter), RV fractional shortening, and S velocity were predictors of RVGLS after KTx. RA conduit strain was also identified as a predictor of RA conduit strain after KTx. Additionally, age, RVEDV, RVESV, RVFAC, and RA reservoir strain before KTx were identified as independent predictors of RA reservoir strain after KTx. The findings of this study demonstrate a significant improvement in right heart function following KTx. Furthermore, strain analysis can provide valuable insights for predicting right heart function after KTx.

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Authors and Affiliations

  1. Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Mohammad Khani & Tooba Akbari

  2. Atherosclerosis Research Center, Jundishapur University of Medical Sciences, Ahvaz, Iran

    Amir Moradi

  3. Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran

    Erfan Ghadirzadeh

  4. Student Research Committee, Golestan University of Medical Sciences, Gorgan, Iran

    Seyed Pooria Salehi Mashhad Sari

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  1. Mohammad Khani
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  3. Erfan Ghadirzadeh
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  4. Seyed Pooria Salehi Mashhad Sari
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Contributions

MK and TA designed the study. AM worked on proper statistical analysis of the data. TA and SPSM collected the data. EG outlined, drafted, and contributed to the writing of the manuscript. All authors contributed to the preparation of the draft, reviewed, and approved the final edition of the manuscript.

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Correspondence to Amir Moradi, Erfan Ghadirzadeh or Tooba Akbari.

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The Research Ethics Committee of Shahid Beheshti University of Medical Sciences reviewed and approved this study (IR.SBMU.retech.1401.291).

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Informed consent was obtained from all individual participants included in the study.

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The authors affirm that human research participants provided informed consent for publication of the images in all Figures.

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Khani, M., Moradi, A., Ghadirzadeh, E. et al. Improvement in right heart function following kidney transplantation in esrd patients: insights from speckle tracking echocardiography analysis. Int J Cardiovasc Imaging (2024). https://doi.org/10.1007/s10554-024-03103-0

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