Objective: Hypertension and left ventricular hypertrophy are highly prevalent post-transplant, however the relationship between echocardiographic structural abnormalities and treatment burden has been poorly characterised. This study aims to describe the relationship between the medication requirements and left ventricular mass index, diastolic dysfunction markers and left atrial enlargement. Design and method: We performed a cross-sectional study on 90 adult renal transplant recipients who underwent echocardiography in our centre. All echocardiographic parameters were recorded and interpreted according to international guidelines. Demographic data and the number of antihypertensive agents were recorded for each patient. Linear regression and ROC analysis established the LVMi threshold for high medication burden (more than three agents). Phenotyping by diastolic dysfunction and left atrial enlargement evaluated their impact on therapy. Results: The mean age of participants was 49.2±11.5 years with a predominantly male distribution (67.7%). Clinical indicators showed a mean eGFR of 61.3±23.7 mL/min/1.53m2 and significant structural remodelling with mean LVMi of 117.6±33.4 g/m2 and LAVi of 41.3±16.2 mL/m2. The mean number of antihypertensive agents was 1.9±0.9 with 27.7% of the patients needing more than three agents. Linear regression showed that only eGFR and LVMi were the independent drivers of therapy intensity (p<0.001, p=0.005). The unadjusted LVMi model had a relatively low discriminatory power in identifying patients with therapeutic resistance (AUC=0.692). The predictive accuracy was increased by accounting for current age, age at transplant and renal function (AUC=0.722). In this model, the threshold of LVMi that predicts the need for more than three agents was shown to be 115.33 g/m2. Diastolic function showed no influence, however high LAVi in addition to ventricular hypertrophy significantly increased the therapeutic burden compared to isolated left atrial enlargement. Conclusions: This study shows that therapeutic resistance is more closely related to structural markers rather than functional abnormalities. Alongside hypertrophy, the presence of left atrial dilation identifies a subgroup of patients with significantly higher antihypertensive medication requirements. The presence of both findings should prompt the clinician to initiate a more intensive treatment regimen.
Iliescu et al. (Fri,) studied this question.