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

Mohammad Khani; Amir Moradi; Erfan Ghadirzadeh; Seyed Pooria Salehi Mashhad Sari; Tooba Akbari

doi:10.1007/s10554-024-03103-0

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

Int J Cardiovasc Imaging. 2024 Apr 23. doi: 10.1007/s10554-024-03103-0. Online ahead of print.

Authors

Mohammad Khani¹, Amir Moradi², Erfan Ghadirzadeh³, Seyed Pooria Salehi Mashhad Sari⁴, Tooba Akbari⁵

Affiliations

¹ Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
² Atherosclerosis Research Center, Jundishapur University of Medical Sciences, Ahvaz, Iran. amir.moradi73@gmail.com.
³ Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran. er.ghadirzadeh@gmail.com.
⁴ Student Research Committee, Golestan University of Medical Sciences, Gorgan, Iran.
⁵ Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Tbaakbari@gmail.com.

PMID: 38652398
DOI: 10.1007/s10554-024-03103-0

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.

Keywords: Kidney transplant; Right atrium; Right ventricle; Strain analysis; Two-dimensional speckle tracking echocardiography.