Oncotarget

Clinical Research Papers:

The prognostic significance of preoperative left ventricular diastolic dysfunction and left atrial enlargement on acute coronary syndrome in kidney transplantation

Jin Ho Hwang, Jun-Bean Park, Yong-Jin Kim, Jung Nam An, Jaeseok Yang, Curie Ahn, In Mok Jung, Chun Soo Lim, Yon Su Kim, Young Hoon Kim and Jung Pyo Lee _

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Oncotarget. 2017; 8:71154-71163. https://doi.org/10.18632/oncotarget.16862

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Abstract

Jin Ho Hwang1, Jun-Bean Park2, Yong-Jin Kim2, Jung Nam An3,4, Jaeseok Yang5, Curie Ahn5,6, In Mok Jung7, Chun Soo Lim3, Yon Su Kim6, Young Hoon Kim8 and Jung Pyo Lee3,6

1Nephrology Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea

2Cardiology Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea

3Nephrology Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea

4Department of Critical Care Medicine, Seoul National University Boramae Medical Center, Seoul, Korea

5Transplantation Center, Seoul National University Hospital, Seoul, Korea

6Nephrology Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea

7Department of Surgery, Seoul National University Boramae Medical Center, Seoul, Korea

8Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea

Correspondence to:

Jung Pyo Lee, email: [email protected]

Young Hoon Kim, email: [email protected]

Keywords: acute coronary syndrome, cardiovascular disease, transthoracic echocardiography, kidney transplantation, renal transplantation

Received: February 08, 2017     Accepted: March 28, 2017     Published: April 05, 2017

ABSTRACT

Echocardiography is commonly performed as a screening test to evaluate perioperative risks before kidney transplantation. However, only limited data are available on echocardiographic parameters of left ventricular diastolic dysfunction (LVDD) and left atrial enlargement (LAE) on acute coronary syndrome and mortality in kidney transplant recipients. We reviewed 2779 adult recipients who underwent pretransplant echocardiography from 1997 to 2012. We divided the patients into two and four groups by two categories: LVDD grades 0–1 vs. 2–3, and left atrial size quartile groups. During a mean follow-up of 4.5 years, acute coronary syndrome occurred in 89 (3.2%) patients. The recipients with LVDD grades 2–3 (P = 0.005 for non-fatal, P = 0.02 for fatal/non-fatal) and LAE (P = 0.001 for non-fatal, P = 0.03 for fatal/non-fatal) had a higher incidence of acute coronary syndrome after kidney transplantation. All-cause mortality did not differ significantly between the groups. In a multivariate analysis, LVDD of grades 2–3 (hazard ratio 2.98, 95% confidence interval 1.535–5.787; P = 0.001), and LAE (hazard ratio 1.052, 95% confidence interval 1.006–1.101; P = 0.03) were independently associated with non-fatal acute coronary syndrome. In patients who are kidney transplant candidates, pretransplant LVDD and LAE were independently associated with a higher incidence of acute coronary syndrome after kidney transplantation.


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