Limits...
Prevalence and predictors of early cardiovascular events after kidney transplantation: evaluation of pre-transplant cardiovascular work-up.

Delville M, Sabbah L, Girard D, Elie C, Manceau S, Piketty M, Martinez F, Méjean A, Legendre C, Sberro-Soussan R - PLoS ONE (2015)

Bottom Line: In total, 244 renal transplant recipients older than 50 years were included.The results of pre-transplant work-up, including clinical evaluation, electrocardiogram, echocardiography, myocardial perfusion testing and coronary angiography were analyzed.Pre-transplantation evaluation allowed the diagnosis of unknown coronary artery lesions in 8.9% of patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology and Transplantation, Hôpital Necker Assistance Publique-Hôpitaux de Paris, Université Paris Descartes Sorbonne Paris Cité, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, RTRS « Centaure », Labex « Transplantex », Paris, France.

ABSTRACT

Introduction: Cardiovascular disease is the leading cause of mortality after renal transplantation. The purpose of this study was to analyze cardiovascular risk factors at transplantation, occurrence of cardiovascular events in the first year after transplantation and evaluate pre-transplant work-up.

Material and method: In total, 244 renal transplant recipients older than 50 years were included. The results of pre-transplant work-up, including clinical evaluation, electrocardiogram, echocardiography, myocardial perfusion testing and coronary angiography were analyzed.

Results: Patients had multiple risk factors at inclusion on renal transplantation waiting list as high blood pressure (94.7%), dyslipidemia (81.1%), smoking (45.3%), diabetes (23.6%), past history of cardiovascular disease (21.3%) and obesity (12.7%). Following transplantation, 15.5% (n = 38) of patients experienced a cardiovascular event, including 2.8% (n = 7) acute coronary syndrome, 5.8% (n = 14) isolated increase in troponin level and 5.3% (n = 13) new onset atrial fibrillation. The pre-transplant parameters associated with a cardiovascular event were a past medical history of cardiovascular disease (HR = 2.06 [1.06-4.03], p = 0.03), echocardiographic left ventricular hypertrophy (HR = 2.04 [1.04-3.98], p = 0.037) and abnormal myocardial perfusion testing (HR = 2.25 [1.09 -5.96], p = 0.03). Pre-transplantation evaluation allowed the diagnosis of unknown coronary artery lesions in 8.9% of patients.

No MeSH data available.


Related in: MedlinePlus

Kaplan-Meier survival curve shows the probability over time to observe a cardiovascular event and IC 95%.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4481263&req=5

pone.0131237.g001: Kaplan-Meier survival curve shows the probability over time to observe a cardiovascular event and IC 95%.

Mentions: A 12 months, follow-up was available for all patients. Overall, 38 (15.5%) renal transplant recipients had a cardiovascular event during the first year post-transplantation as follows: ACS with ST-segment elevation and increased troponin levels in 7 patients (2.8%), ACS without ST-segment elevation in 14 (5.8%), acute pulmonary edema associated with ACS without ST-segment elevation in 4 (1.6%) and atrial fibrillation in 13 (5.3%). One patient was resuscitated following cardiac arrest related to ventricular fibrillation. Five patients died of non cardiovascular causes (4 sepsis and 1 intracerebral tumor). Kaplan-Meier survival curve (Fig 1) showed the probability over time to observe a cardiovascular event. The probability to have a cardiovascular event was 16% [11%–20%]. The median time of cardiac event occurrence in these 38 patients was 5 days [2–12]. Patients with ACS with ST-segment modification were all men. The median age was 59 years old [51–66]. Mean hemoglobin level in these patients event was 9.8 g/dl ± 1.6. Patients presenting a SCA with ST-segment modification had a trend to more delayed graft function with a serum creatinine at event 613 ± 258 μmol/l vs 433 ± 278 μmol/l and an increased of overload syndrome with an increase of body weight of 3.58 ± 3.23 kg vs 2.93 ± 3.3 kg compared to other event. These results are not significant because of population’s small size. Mean left atrium at pre-transplant echocardiography was 39,5 ± 6.6 mm and was above 46 mm in 6 patients. Among the 6 patients showing aortic valves calcifications at pre-transplant work-up 3 observed atrial fibrillation.


Prevalence and predictors of early cardiovascular events after kidney transplantation: evaluation of pre-transplant cardiovascular work-up.

Delville M, Sabbah L, Girard D, Elie C, Manceau S, Piketty M, Martinez F, Méjean A, Legendre C, Sberro-Soussan R - PLoS ONE (2015)

Kaplan-Meier survival curve shows the probability over time to observe a cardiovascular event and IC 95%.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4481263&req=5

pone.0131237.g001: Kaplan-Meier survival curve shows the probability over time to observe a cardiovascular event and IC 95%.
Mentions: A 12 months, follow-up was available for all patients. Overall, 38 (15.5%) renal transplant recipients had a cardiovascular event during the first year post-transplantation as follows: ACS with ST-segment elevation and increased troponin levels in 7 patients (2.8%), ACS without ST-segment elevation in 14 (5.8%), acute pulmonary edema associated with ACS without ST-segment elevation in 4 (1.6%) and atrial fibrillation in 13 (5.3%). One patient was resuscitated following cardiac arrest related to ventricular fibrillation. Five patients died of non cardiovascular causes (4 sepsis and 1 intracerebral tumor). Kaplan-Meier survival curve (Fig 1) showed the probability over time to observe a cardiovascular event. The probability to have a cardiovascular event was 16% [11%–20%]. The median time of cardiac event occurrence in these 38 patients was 5 days [2–12]. Patients with ACS with ST-segment modification were all men. The median age was 59 years old [51–66]. Mean hemoglobin level in these patients event was 9.8 g/dl ± 1.6. Patients presenting a SCA with ST-segment modification had a trend to more delayed graft function with a serum creatinine at event 613 ± 258 μmol/l vs 433 ± 278 μmol/l and an increased of overload syndrome with an increase of body weight of 3.58 ± 3.23 kg vs 2.93 ± 3.3 kg compared to other event. These results are not significant because of population’s small size. Mean left atrium at pre-transplant echocardiography was 39,5 ± 6.6 mm and was above 46 mm in 6 patients. Among the 6 patients showing aortic valves calcifications at pre-transplant work-up 3 observed atrial fibrillation.

Bottom Line: In total, 244 renal transplant recipients older than 50 years were included.The results of pre-transplant work-up, including clinical evaluation, electrocardiogram, echocardiography, myocardial perfusion testing and coronary angiography were analyzed.Pre-transplantation evaluation allowed the diagnosis of unknown coronary artery lesions in 8.9% of patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology and Transplantation, Hôpital Necker Assistance Publique-Hôpitaux de Paris, Université Paris Descartes Sorbonne Paris Cité, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, RTRS « Centaure », Labex « Transplantex », Paris, France.

ABSTRACT

Introduction: Cardiovascular disease is the leading cause of mortality after renal transplantation. The purpose of this study was to analyze cardiovascular risk factors at transplantation, occurrence of cardiovascular events in the first year after transplantation and evaluate pre-transplant work-up.

Material and method: In total, 244 renal transplant recipients older than 50 years were included. The results of pre-transplant work-up, including clinical evaluation, electrocardiogram, echocardiography, myocardial perfusion testing and coronary angiography were analyzed.

Results: Patients had multiple risk factors at inclusion on renal transplantation waiting list as high blood pressure (94.7%), dyslipidemia (81.1%), smoking (45.3%), diabetes (23.6%), past history of cardiovascular disease (21.3%) and obesity (12.7%). Following transplantation, 15.5% (n = 38) of patients experienced a cardiovascular event, including 2.8% (n = 7) acute coronary syndrome, 5.8% (n = 14) isolated increase in troponin level and 5.3% (n = 13) new onset atrial fibrillation. The pre-transplant parameters associated with a cardiovascular event were a past medical history of cardiovascular disease (HR = 2.06 [1.06-4.03], p = 0.03), echocardiographic left ventricular hypertrophy (HR = 2.04 [1.04-3.98], p = 0.037) and abnormal myocardial perfusion testing (HR = 2.25 [1.09 -5.96], p = 0.03). Pre-transplantation evaluation allowed the diagnosis of unknown coronary artery lesions in 8.9% of patients.

No MeSH data available.


Related in: MedlinePlus