肾移植对终末期肾病患者左室心肌变形的影响

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2025-04-17 DOI:10.1111/ctr.70150

Manish Jain, Rakesh Bhat, Hardeep Kaur Grewal, Ashish Nandwani, Dinesh Yadav, Pranaw Kumar Jha, Shyam Bansal, Dinesh Bansal, Vijay Kher, Manish Bansal

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引用次数: 0

摘要

背景终末期肾病（ESRD）与显著的左心室（LV）重构相关。然而，肾移植对左室重构的影响尚未得到充分阐明。方法对42例肾移植患者（平均年龄39.1±11.0岁，男性79%）在移植前后（中位时间间隔239天，四分位间距149 ~ 328天）行超声心动图检查。还包括45名年龄和性别匹配的健康对照组。结果ESRD患者左室质量指数、左房容积指数（LAVI）和舒张早期二尖瓣流入速度与二尖瓣环速度之比（E/ E’）均显著升高，左室总纵应变（GLS）、周向应变、心尖旋转和扭转均显著降低。左室射血分数（LVEF）也较低，但左室总径向应变（GRS）在两组间无显著差异。肾移植后这些异常大多得到改善。近三分之一的患者LVEF至少改善了10%，大约一半的患者二尖瓣E/ E’比和左室整体纵向和周向应变改善了10%或更多。结论肾移植后左室肥厚明显消退，左室心肌变形明显改善，左室收缩和舒张功能明显改善。需要进一步大规模和长期的研究来确定这些变化的预测因素和临床意义。

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Effect of Renal Transplantation on Left Ventricular Myocardial Deformation in Patients With End-Stage Renal Disease

Background

End-stage renal disease (ESRD) is associated with significant left ventricular (LV) remodeling. However, the impact of renal transplantation on LV remodeling has not been adequately elucidated.

Methods

A comprehensive echocardiography was performed before and after (median time interval 239 days, interquartile range 149–328 days) renal transplantation in 42 patients (mean age 39.1 ± 11.0 years, 79% men). Forty-five apparently healthy age- and gender-matched controls were also included.

Results

The patients with ESRD had significantly increased LV mass index, left atrial volume index (LAVI), and the ratio of early diastolic mitral inflow velocity to mitral annular velocity (E/e’), whereas LV global longitudinal strain (GLS), circumferential strain, apical rotation, and twist were reduced. LV ejection fraction (LVEF) was also lower, but the LV global radial strain (GRS) was not different between the two groups. Most of these abnormalities showed improvement after renal transplantation. Nearly one-third of all patients had at least a 10% improvement in LVEF, and roughly half had a 10% or more improvement in the mitral E/e’ ratio and the LV global longitudinal and circumferential strain.

Conclusion

This study shows that renal transplantation results in a significant regression of LV hypertrophy and an improvement in LV myocardial deformation translating into an improvement in the LV systolic and diastolic function. Further larger and long-term studies are needed to identify the predictors and the clinical significance of these changes.

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.