Left Atrial and Ventricular Deformation: Alterations and Predictive Value of Echocardiography Parameters in End-Stage Renal Disease Patients after Kidney Transplantation

Abstract

End-stage renal disease (ESRD) patients are prone to alterations in cardiac hemodynamics specifically on the left ventricle (LV) and left atrial (LA) functions usually due to factors like uremia, fluid overload, and inflammation. While studies on LV function in ESRD exist, research on LA function is limited. Successful KTx is believed to reverse pathological cardiac remodeling, and monitoring changes in cardiac strain before and after transplantation may guide pre and posttransplant care. This study has two main objectives: to investigate alterations in LA and LV strain and other echocardiographic parameters after KTx and to identify independent factors predicting impaired strain parameters post-KTx. We conducted a prospective cohort study of 49 ESRD patients who underwent KTx. Echocardiography was performed at baseline and at three months after KTx. LV end-diastolic volume, LV end-systolic volume, LV end-diastolic diameter, LV ejection fraction (LVEF), E/e’, maximum LA volume index (LAVi), LV global longitudinal strain (LVGLS), and all LA strain values, including booster (LASb), conduit (LAScd), and reservoir (LASr), improved significantly after KTx (P < 0.05). Regarding independent predictors of impaired LA and LV strains, pre-KTx values of LVEF, LAVi, and NT-proBNP were associated with LVGLS impairment after KTx; pre-KTx values of LAVi and LVEF were associated with LASr impairment after KTx. The present study provided valuable evidence on the effects of KTx on uremic cardiomyopathy demonstrated by LA strain and LV strain improvements, and indicated pre-KTx LVEF and LAVi as significant independent predictors of LVGLS and LASr impairment after KTx.