Patel Rajan K, Mark Patrick B, Johnston Nicola, McGregor Ellon, Dargie Henry J, Jardine Alan G
BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
Clin J Am Soc Nephrol. 2008 Nov;3(6):1807-11. doi: 10.2215/CJN.01400308. Epub 2008 Jul 23.
Patients with end-stage renal failure (ESRD) have an increased risk of premature cardiovascular (CV) disease. Left ventricular hypertrophy is an independent risk factor for CV events and death in ESRD. Renal transplantation has been associated with reduction in CV risk and echocardiographic regression of left ventricular hypertrophy. However, echocardiography overestimates LV mass in ESRD patients. Cardiac magnetic resonance (CMR) provides more detailed, volume-independent, measures of cardiac structure. Changes in LV mass measured by CMR after renal transplantation were studied.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Fifty patients underwent CMR on two occasions. Twenty-five were transplanted before the second scan. CMR was performed to measure LV mass index (LVMI), ejection fraction, end-diastolic and end-systolic volumes. Changes were expressed as percentage change over time. Patients with CV events between scans (e.g., acute coronary syndrome, myocardial infarction) were excluded. All transplant patients had serum creatinine <150 mumol/L.
There was no significant change in LVMI between patients who underwent renal transplantation and those who remained on dialysis (transplanted mean, 2.75%/yr, +/- 9.1 versus dialysis, -3.6%/yr +/- 16.7). In addition, there were no significant changes in end-diastolic volume (transplant, 0.1%/yr +/- 19.5 versus not transplanted, -3.4%/yr +/- 31.5), end-systolic volume (transplanted mean, 15.2%/yr +/- 65.2 versus not transplanted, 3.0%/yr +/- 55.5), or ejection fraction (transplant, 2.1%/yr +/- 11.9 versus not transplanted, -0.4%/yr +/- 5.3).
Renal transplantation is not associated with significant regression of LVMI on CMR compared with patients who remain on the transplant waiting list.
终末期肾衰竭（ESRD）患者发生心血管（CV）疾病过早的风险增加。左心室肥厚是ESRD患者发生CV事件和死亡的独立危险因素。肾移植与CV风险降低及左心室肥厚的超声心动图消退有关。然而，超声心动图高估了ESRD患者的左心室质量。心脏磁共振成像（CMR）能提供更详细的、与容积无关的心脏结构测量方法。本研究探讨了肾移植后通过CMR测量的左心室质量变化。
设计、地点、参与者及测量方法：50例患者接受了两次CMR检查。其中25例在第二次扫描前接受了肾移植。通过CMR测量左心室质量指数（LVMI）、射血分数、舒张末期和收缩末期容积。变化以随时间的百分比变化表示。排除两次扫描之间发生CV事件（如急性冠状动脉综合征、心肌梗死）的患者。所有移植患者的血清肌酐<150μmol/L。
接受肾移植的患者与仍接受透析的患者相比，LVMI无显著变化（移植组平均每年变化2.75%，±9.1，透析组为-3.6%/年±16.7）。此外，舒张末期容积（移植组每年变化0.1%，±19.5，未移植组为-3.4%/年±31.5）、收缩末期容积（移植组平均每年变化15.2%，±65.2，未移植组为3.0%/年±55.5）或射血分数（移植组每年变化2.1%，±11.9，未移植组为-0.4%/年±5.3）均无显著变化。
与仍在移植等待名单上的患者相比，肾移植与CMR测量的LVMI显著消退无关。
