What is the clinical evidence from this study?

Study design: Observational. Population: Renal transplant candidates (n=2718). Intervention: Systolic dysfunction (LVEF ≤0.40) vs. Normal systolic function. Primary outcome: All-cause mortality (HR 1.7, 95% CI 1.43-2.07, p=<0.001).

March 28, 2008Journal of the American Society of Nephrology

Systolic Dysfunction Portends Increased Mortality among Those Waiting for Renal Transplant

Q: What are the key findings of this study?

Systolic dysfunction (LVEF ≤0.40) in renal transplant candidates was independently associated with increased all-cause mortality compared to normal systolic function (adjusted HR 1.7; 95% CI 1.43-2.07).

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Key result

Systolic dysfunction (LVEF ≤0.40) in renal transplant candidates was independently associated with increased all-cause mortality compared to normal systolic function (adjusted HR 1.7; 95% CI 1.43-2.07).

Why the study?

Does systolic dysfunction increase mortality in renal transplant candidates?

Study Design

Type

Observational (n=2,718)

Multicenter

Structured PICO

Does systolic dysfunction increase mortality in renal transplant candidates?

Population

2,718 renal transplant candidates without prior heart failure who underwent stress-SPECT imaging, followed for a median of 27 months.

Exposure

Systolic dysfunction (LVEF ≤0.40) assessed by stress-SPECT imaging

Comparator

Normal systolic function (LVEF >0.40)

Outcome

All-cause mortalityhard clinical

Main Result

Hazard Ratio: 1.7 (95% CI 1.43–2.07)

p-value: p=<0.001

Systolic dysfunction is strongly and independently associated with increased all-cause and cardiac mortality in a graded manner among renal transplant candidates.

Limitations

Specific causes of death were unknown in one third of cases
LVEF measurements by two modalities were limited to 446 patients
LVEF measurements were not systematically repeated
No adjustments for interim therapies
Angiograms were not performed for all patients with decreased LVEF
No assessment of diastolic dysfunction
Data were limited to the period spent on the waiting list
Measurements of LVEF by two modalities (SPECT and 2DE) were limited to 446 patients
No adjustments for interim therapies were made
Angiograms were not performed for all patients with decreased LVEF to fully ascertain coronary artery disease

Authors

AMAngelo M. de MattosOregon Health & Science University ASAndrew M. SiedleckiBrigham and Women's Hospital RGRobert S. GastonWest Virginia University

Discussion

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Implication

Reduced LVEF was associated with mortality in renal transplant candidates; hypothesis-generating and leaves open need for prospective validation.

Cite This Study

Mattos et al. (2008) conducted an observational in Renal transplant candidates (n=2,718). Systolic dysfunction (LVEF ≤0.40) vs. Normal systolic function was evaluated on All-cause mortality (HR 1.7, 95% CI 1.43-2.07, p=<0.001). Systolic dysfunction (LVEF ≤0.40) in renal transplant candidates was independently associated with increased all-cause mortality compared to normal systolic function (adjusted HR 1.7; 95% CI 1.43-2.07).

synapsesocial.com/papers/6a653f9d1ee39a729139dd24 https://doi.org/10.1681/asn.2007040503

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Implication

Reduced LVEF was associated with mortality in renal transplant candidates; hypothesis-generating and leaves open need for prospective validation.

Systolic Dysfunction Portends Increased Mortality among Those Waiting for Renal Transplant

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Systolic Dysfunction Portends Increased Mortality among Those Waiting for Renal Transplant

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Also Consider

Also Consider