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

// Jin Ho Hwang 1 , Jun-Bean Park 2 , Yong-Jin Kim 2 , Jung Nam An 3, 4 , Jaeseok Yang 5 , Curie Ahn 5, 6 , In Mok Jung 7 , Chun Soo Lim 3 , Yon Su Kim 6 , Young Hoon Kim 8 and Jung Pyo Lee 3, 6 1 Nephrology Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea 2 Cardiology Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea 3 Nephrology Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea 4 Department of Critical Care Medicine, Seoul National University Boramae Medical Center, Seoul, Korea 5 Transplantation Center, Seoul National University Hospital, Seoul, Korea 6 Nephrology Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea 7 Department of Surgery, Seoul National University Boramae Medical Center, Seoul, Korea 8 Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea Correspondence to: Jung Pyo Lee, email: nephrolee@gmail.com Young Hoon Kim, email: gskyh@amc.seoul.kr 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.