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Time-dependent cardiac structural and functional changes after kidney transplantation: a multi-parametric cardiac magnetic resonance study

  • Cardiac
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Abstract

Objectives

To map time-dependent cardiac structural and functional change patterns after renal transplantation (KT) using cardiac magnetic resonance (CMR).

Methods

Fifty-three patients with pre-KT and post-KT CMR exams were retrospectively analyzed. Patients were divided into three groups according to the time of post-KT CMR: group 1 (3 months post-KT, n = 16), group 2 (6 months post-KT, n = 21), and group 3 (over 9 months post-KT, n = 16). Twenty-one age- and sex-matched healthy controls (HC) were recruited for the study. CMR-derived left ventricular (LV) volumes, LV mass index (LVMi), LV ejection fraction (LVEF), global radial strain (GRS), global circumferential strain (GCS), global longitudinal strain (GLS), and native T1 value were compared. The association between the changes of CMR parameters was assessed.

Results

LVMi post-KT decreased in groups 2 (p < 0.001) and 3 (p = 0.004) but both groups had higher LVMi values compared to HC (both p < 0.001). GLS post-KT was decreased in group 1 (p = 0.021), but slightly increased in group 2 (p = 0.728) and group 3 (p = 0.100) without significant difference. GLS post-KT in group 3 was not different from HC (p = 0.104). LVEF, GRS, and GCS post-KT in groups 2 and 3 significantly increased and showed no significant difference from HC. The post-KT native T1 value in all three groups significantly decreased; however, no group showed any significant difference from HC. The change of LVEF was associated with the change of GCS, GRS, and GLS.

Conclusions

Although GRS, GCS, GLS, and native T1 values reversed to normal level, LVMi remained impaired in median 14 months after KT.

Key Points

• Kidney transplantation has favorable effects on cardiac structure and function.

• In a median 14 months of follow-up after KT, left ventricle strain and native T1 value reversed to normal level while LV mass index (LVMi) did not. Left ventricular hypertrophy may help to explain why KT recipients are still at increased cardiovascular risk.

• The reason for the decrease of native T1 value after KT may be more than myocardial fibrosis and needs to be further studied.

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Abbreviations

BMI:

Body mass index

CMR:

Cardiac magnetic resonance

ESRD:

End-stage renal disease

GCS:

Global circumferential strain

GLS:

Global longitudinal strain

GRS:

Global radial strain

HC:

Healthy control

HD:

Hemodialysis

KT:

Kidney transplantation

LVEDVi:

Left ventricular end-diastolic volume index

LVEF:

Left ventricular ejection fraction

LVESVi:

Left ventricular end-systolic volume index

LVMi:

Left ventricular mass index

LVSVi:

Left ventricular stroke volume index

PD:

Peritoneal dialysis

References

  1. Cozzolino M, Mangano M, Stucchi A et al (2018) Cardiovascular disease in dialysis patients. Nephrol Dial Transplant 33:iii28–iii34

    Article  CAS  Google Scholar 

  2. Wolfe RA, Ashby VB, Milford EL et al (1999) Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med 341:1725–1730

    Article  CAS  Google Scholar 

  3. Anavekar NS, McMurray JJ, Velazquez EJ (2004) Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction. N Engl J Med 351:1285–1295

    Article  CAS  Google Scholar 

  4. Saran R, Robinson B, Abbott KC et al (2018) US renal data system 2017 annual data report: epidemiology of kidney disease in the United States. Am J Kidney Dis 71:A7

    Article  Google Scholar 

  5. Rangaswami J, Mathew RO, Parasuraman R et al (2019) Cardiovascular disease in the kidney transplant recipient: epidemiology, diagnosis and management strategies. Nephrol Dial Transplant 34:760–773

    Article  CAS  Google Scholar 

  6. Ying T, Shi B, Kelly PJ et al (2020) Death after kidney transplantation: an analysis by era and time post-transplant. J Am Soc Nephrol 31:2887–2899

    Article  CAS  Google Scholar 

  7. Meier-Kriesche HU, Schold JD, Srinivas TR et al (2004) Kidney transplantation halts cardiovascular disease progression in patients with end-stage renal disease. Am J Transplant 4:1662–1668

    Article  Google Scholar 

  8. Taylor AJ, Salerno M, Dharmakumar R et al (2016) T1 mapping: basic techniques and clinical applications. JACC Cardiovasc Imaging 9:67–81

    Article  Google Scholar 

  9. Muscogiuri G, Suranyi P, Schoepf UJ et al (2018) Cardiac magnetic resonance T1-mapping of the myocardium: technical background and clinical relevance. J Thorac Imaging 33:71–80

    Article  Google Scholar 

  10. Seetharam K, Lerakis S (2019) Cardiac magnetic resonance imaging: the future is bright. F1000Res 8:F1000 Faculty Rev-1636

    Article  Google Scholar 

  11. Diao KY, Yang ZG, Xu HY et al (2016) Histologic validation of myocardial fibrosis measured by T1 mapping: a systematic review and meta-analysis. J Cardiovasc Magn Reson 18:92

    Article  Google Scholar 

  12. Bull S, White SK, Piechnik SK et al (2013) Human non-contrast T1 values and correlation with histology in diffuse fibrosis. Heart 99:932–937

    Article  Google Scholar 

  13. Pedrizzetti G, Claus P, Kilner PJ et al (2016) Principles of cardiovascular magnetic resonance feature tracking and echocardiographic speckle tracking for informed clinical use. J Cardiovasc Magn Reson 18:51

    Article  Google Scholar 

  14. Hayer MK, Radhakrishnan A, Price AM et al (2019) Early effects of kidney transplantation on the heart - a cardiac magnetic resonance multi-parametric study. Int J Cardiol 293:272–277

    Article  Google Scholar 

  15. Contti MM, Barbosa MF, Del Carmen Villanueva Mauricio A et al (2019) Kidney transplantation is associated with reduced myocardial fibrosis. A cardiovascular magnetic resonance study with native T1 mapping. J Cardiovasc Magn Reson 21:21

    Article  Google Scholar 

  16. Gong IY, Al-Amro B, Prasad GVR et al (2018) Cardiovascular magnetic resonance left ventricular strain in end-stage renal disease patients after kidney transplantation. J Cardiovasc Magn Reson 20:83

    Article  Google Scholar 

  17. Koo TK, Li MY (2016) A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 15:155–163

    Article  Google Scholar 

  18. Cafka M, Rroji M, Seferi S et al (2016) Inflammation, left ventricular hypertrophy, and mortality in end-stage renal disease. Iran J Kidney Dis 10:217–223

    PubMed  Google Scholar 

  19. Paoletti E (2012) Left ventricular hypertrophy and progression of chronic kidney disease. J Nephrol 25:847–850

    Article  Google Scholar 

  20. Lorell BH, Carabello BA (2000) Left ventricular hypertrophy: pathogenesis, detection, and prognosis. Circulation 102:470–479

    Article  CAS  Google Scholar 

  21. Gosse P, Dallocchio M (1993) Left ventricular hypertrophy: epidemiological prognosis and associated critical factors. Eur Heart J 14(Suppl D):16–21

    Article  Google Scholar 

  22. Omrani H, Rai A, Daraei Z et al (2017) Study of echocardiographic changes after kidney transplantation in end-stage renal disease patients. Med Arch 71:408–411

    Article  Google Scholar 

  23. Zitzelsberger T, Scholz A, Hetterich H et al (2020) Magnetic resonance-based assessment of myocardial 2-dimensional strain using feature tracking: association with cardiovascular risk factors in a population-based cohort free of cardiovascular disease. J Thorac Imaging 35:49–55

    Article  Google Scholar 

  24. Romano S, Judd RM, Kim RJ et al (2017) Association of feature-tracking cardiac magnetic resonance imaging left ventricular global longitudinal strain with all-cause mortality in patients with reduced left ventricular ejection fraction. Circulation 135:2313–2315

    Article  Google Scholar 

  25. Romano S, Judd RM, Kim RJ et al (2020) Feature-tracking global longitudinal strain predicts mortality in patients with preserved ejection fraction: a multicenter study. JACC Cardiovasc Imaging 13:940–947

    Article  Google Scholar 

  26. Kalam K, Otahal P, Marwick TH (2014) Prognostic implications of global LV dysfunction: a systematic review and meta-analysis of global longitudinal strain and ejection fraction. Heart 100:1673–1680

    Article  Google Scholar 

  27. Barbosa MF, Contti MM, de Andrade LGM et al (2021) Feature-tracking cardiac magnetic resonance left ventricular global longitudinal strain improves 6 months after kidney transplantation associated with reverse remodeling, not myocardial tissue characteristics. Int J Cardiovasc Imaging 37:3027–3037

    Article  Google Scholar 

  28. Mall G, Rambausek M, Neumeister A et al (1988) Myocardial interstitial fibrosis in experimental uremia--implications for cardiac compliance. Kidney Int 33:804–811

    Article  CAS  Google Scholar 

  29. Aoki J, Ikari Y, Nakajima H et al (2005) Clinical and pathologic characteristics of dilated cardiomyopathy in hemodialysis patients. Kidney Int 67:333–340

    Article  Google Scholar 

  30. Charytan DM, Padera R, Helfand AM et al (2014) Increased concentration of circulating angiogenesis and nitric oxide inhibitors induces endothelial to mesenchymal transition and myocardial fibrosis in patients with chronic kidney disease. Int J Cardiol 176:99–109

    Article  Google Scholar 

  31. Kaesler N, Babler A, Floege J, Kramann R (2020) Cardiac remodeling in chronic kidney disease. Toxins (Basel) 12:161

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Funding

This study has received funding by the National Natural Science Foundation of China (No. 81501448).

Author information

Authors and Affiliations

  1. Department of Diagnostic Radiology, Jinling Hospital, Nanjing Medical University, Nanjing, 210002, Jiangsu, China

    Li Qi, Wei Wang, Lingyan Zhang & Long Jiang Zhang

  2. Department of Nephrology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China

    Xuefeng Ni & Jiqiu Wen

  3. Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA

    U. Joseph Schoepf, Akos Varga-Szemes & Liam McGill

  4. Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China

    Song Luo & Long Jiang Zhang

Authors
  1. Li Qi
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  2. Xuefeng Ni
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  3. U. Joseph Schoepf
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  4. Akos Varga-Szemes
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  6. Wei Wang
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  7. Lingyan Zhang
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  8. Song Luo
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  9. Jiqiu Wen
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  10. Long Jiang Zhang
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Corresponding authors

Correspondence to Jiqiu Wen or Long Jiang Zhang.

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Guarantor

The scientific guarantor of this publication is Longjiang Zhang.

Conflict of interest

The authors declare no competing interests.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethics approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• observational study

• performed at one institution

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Supplementary information

Supplemental Figure 1

. Changes in LVMi (A), LVEF (B), GRS (C), GCS (D), GLS (E) and native T1 value (F) between baseline and follow-up CMR in the three KT groups. KT: kidney transplantation; LVMi: left ventricular mass index; LVEF: left ventricular ejection fraction; GRS: global radial strain; GCS: global circumferential strain; GLS: global longitudinal strain (PNG 5326 kb)

High resolution image (TIF 630 kb)

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Qi, L., Ni, X., Schoepf, U.J. et al. Time-dependent cardiac structural and functional changes after kidney transplantation: a multi-parametric cardiac magnetic resonance study. Eur Radiol 32, 5265–5275 (2022). https://doi.org/10.1007/s00330-022-08621-w

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  • DOI: https://doi.org/10.1007/s00330-022-08621-w

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