Key result
Better pre-transplant RV free wall strain is linked to ~3% lower post-kidney transplant MACE risk per 1%.
Why the study?
The hemodynamic effects of end-stage kidney disease and associated pulmonary hypertension may impair RV function, prompting evaluation of whether pre-transplant echocardiographic RV function parameters, including RV strain, are associated with long-term CV outcomes after kidney transplantation.
Does pre-transplant echocardiographic right ventricular strain predict long-term major adverse cardiovascular events in adult kidney transplant recipients?
Cohort (n=371)
Single-blind
No
Does pre-transplant echocardiographic right ventricular strain predict long-term major adverse cardiovascular events in adult kidney transplant recipients?
Pre-transplant right ventricular free wall strain (specifically average, mid, and apical strain), unlike conventional RV echocardiographic parameters, is independently associated with long-term major adverse cardiovascular events following kidney transplantation and may improve pre-transplant cardiovascular risk stratification.
Answers are grounded in this paper and cite their sources.
May refine pre-transplant risk stratification in kidney recipients; extends prior RV strain associations but remains hypothesis-generating.
The hemodynamic effects of end-stage kidney disease and associated pulmonary hypertension may impair right ventricular (RV) function and influence cardiovascular (CV) outcomes after kidney transplantation (KT). We aimed to evaluate the association between pre-transplant echocardiographic RV function parameters, including RV strain, and long-term CV outcomes following KT. In this retrospective cohort study, we included adult KT recipients at a single Midwest academic center from 2015 to 2024 who had adequate-quality pre-transplant echocardiograms and follow-up at our institution. RV function parameters included tricuspid annular systolic velocity (S′), tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), RV index of myocardial performance (RIMP), and RV free wall strain measured by two-dimensional speckle-tracking echocardiography. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of CV death, non-fatal myocardial infarction, cerebrovascular accident, heart failure hospitalization, coronary revascularization, or sustained ventricular arrhythmias. Among 371 patients (mean age 53.5 ± 13.1 years; 56% male) followed for a median of 4.9 years (IQR, 3.1–6.4), 79 (21.2%) experienced MACE. On univariable Cox analysis, RIMP and RV strain parameters were associated with MACE, whereas S′, TAPSE, and FAC were not. Kaplan–Meier analysis showed lower MACE-free survival in patients with abnormal mid and apical RV strain, whereas the basal and dichotomized average-strain comparisons were not significant. In multivariable models, only average, mid, and apical RV strain remained independently associated with MACE. Pre-transplant RV strain was independently associated with long-term MACE after KT and may aid CV risk stratification. Further studies are needed to validate these findings.
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Lawrence et al. (2026) conducted a cohort in Kidney transplantation / End-stage kidney disease (n=371). Pre-transplant right ventricular free wall strain (per 1% increment in strain magnitude) vs. Lower right ventricular strain magnitude / Conventional RV function parameters was evaluated on Major adverse cardiovascular events (MACE: composite of cardiovascular death, non-fatal myocardial infarction, cerebrovascular accident, heart failure hospitalization, coronary revascularization, or sustained ventricular arrhythmias) (HR 0.97, 95% CI 0.94-1.00, p=0.027). Pre-transplant average right ventricular free wall strain was independently associated with lower long-term MACE risk after kidney transplantation (HR 0.97 per 1% magnitude increment; p=0.027).
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