Adult Echocardiography Cardiothoracic Centre and Department of Renal Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Nephron Clin Pract. 2014;126(1):75-80. doi: 10.1159/000358885. Epub 2014 Mar 7.
Cardiovascular disease is a leading cause of morbidity and mortality after renal transplantation. We analysed whether pre-transplant transthoracic echocardiograms (TTE) predicted major adverse cardiovascular events (MACE) after transplant.
We retrospectively analysed clinical and TTE data from patients having renal transplantation at a single centre between 1 January 2000 and 31 December 2010. The TTE were classified as: group A - normal; group B - mild abnormalities expected in renal failure; group C - moderate to severe abnormalities likely to change management. They were also scored based on four independent risk factors [age ≥50, left ventricular (LV) end systolic diameter ≥3.5 cm, LV wall thickness ≥1.4 cm and mitral annulus calcification]. Post-transplantation clinical notes were examined for MACE (death, stroke, myocardial infarction, and surgical or percutaneous revascularisation).
There were 343 patients, mean age 47 (range 21-83) years, 210 of whom were male. MACE occurred in 29 (8.5%) at a mean of 3.6 (SD 3.3) years after transplantation. They were older (p ≤ 0.001), had larger LV mass (p = 0.02), LV wall thickness (p = 0.008) and left atrial size (p = 0.001) than those without MACE. The MACE rate for groups A, B and C were 1.8, 13.6 and 16.4% (p ≤ 0.001), respectively. Using the score, the risk of MACE was 4.7, 10.7, 9.2 and 40% for scores 0, 1, 2 and 3 (p = 0.023), respectively.
Preoperative transthoracic echocardiography identifies patients at risk of death or non-fatal cardiovascular events even late after renal transplantation. This suggests that echocardiography might be useful to identify patients requiring more aggressive long-term treatment of modifiable vascular risk factors.
心血管疾病是肾移植后发病率和死亡率的主要原因。我们分析了移植前胸超声心动图（TTE）是否可预测移植后的主要不良心血管事件（MACE）。
我们回顾性分析了 2000 年 1 月 1 日至 2010 年 12 月 31 日在一家中心接受肾移植的患者的临床和 TTE 数据。TTE 分为：A 组 - 正常；B 组 - 肾功能衰竭中预期的轻度异常；C 组 - 可能改变治疗方案的中度至重度异常。它们还根据四个独立的危险因素[年龄≥50 岁，左心室（LV）收缩末期直径≥3.5cm，LV 壁厚度≥1.4cm 和二尖瓣环钙化]进行评分。检查移植后临床记录以确定 MACE（死亡、中风、心肌梗死以及手术或经皮血运重建）。
共有 343 名患者，平均年龄为 47 岁（范围 21-83 岁），其中 210 名男性。MACE 发生率为 29 例（8.5%），平均发生在移植后 3.6 年（标准差 3.3 年）。与无 MACE 组相比，MACE 组患者年龄更大（p≤0.001），左心室质量（p=0.02）、LV 壁厚度（p=0.008）和左心房大小（p=0.001）更大。A、B 和 C 组的 MACE 发生率分别为 1.8%、13.6%和 16.4%（p≤0.001）。使用评分，0、1、2 和 3 分的 MACE 风险分别为 4.7%、10.7%、9.2%和 40%（p=0.023）。
移植前胸超声心动图可识别出肾移植后死亡或非致命性心血管事件风险较高的患者。这表明，超声心动图可能有助于识别需要更积极治疗可改变血管危险因素的患者。
