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Predictive Value of Echocardiographic Abnormalities and the Impact of Diastolic Dysfunction on In-hospital Major Cardiovascular Complications after Living Donor Kidney Transplantation

 Eun Jung Kim  ;  Suyon Chang  ;  So Yeon Kim  ;  Kyu Ha Huh  ;  Soojeong Kang  ;  Yong Seon Choi 
 International Journal of Medical Sciences, Vol.13(8) : 620-628, 2016 
Journal Title
 International Journal of Medical Sciences 
Issue Date
Aged ; Cardiovascular Diseases/diagnosis* ; Cardiovascular Diseases/diagnostic imaging ; Cardiovascular Diseases/etiology ; Cardiovascular Diseases/physiopathology ; Echocardiography, Doppler ; Female ; Heart Failure, Diastolic/diagnosis* ; Heart Failure, Diastolic/diagnostic imaging ; Heart Failure, Diastolic/etiology ; Heart Failure, Diastolic/physiopathology ; Humans ; Kidney Failure, Chronic/complications ; Kidney Failure, Chronic/diagnosis ; Kidney Failure, Chronic/diagnostic imaging ; Kidney Failure, Chronic/physiopathology* ; Kidney Transplantation/adverse effects* ; Living Donors ; Male ; Middle Aged ; Predictive Value of Tests ; Pulmonary Edema/diagnosis* ; Pulmonary Edema/diagnostic imaging ; Pulmonary Edema/physiopathology ; Risk Factors
diastolic dysfunction ; end-stage renal disease ; living donor kidney transplantation ; pulmonary edema ; tissue Doppler imaging
Patients with end-stage renal disease (ESRD) show characteristic abnormalities in cardiac structure and function. We evaluated the influence of these abnormalities on adverse cardiopulmonary outcomes after living donor kidney transplantation in patients with valid preoperative transthoracic echocardiographic evaluation. We then observed any development of major postoperative cardiovascular complications and pulmonary edema until hospital discharge. In-hospital major cardiovascular complications were defined as acute myocardial infarction, ventricular fibrillation/tachycardia, cardiogenic shock, newly-onset atrial fibrillation, clinical pulmonary edema requiring endotracheal intubation or dialysis. Among the 242 ESRD study patients, 9 patients (4%) developed major cardiovascular complications, and 39 patients (16%) developed pulmonary edema. Diabetes, ischemia-reperfusion time, left ventricular end-diastolic diameter (LVEDd), left ventricular mass index (LVMI), right ventricular systolic pressure (RVSP), left atrium volume index (LAVI), and high E/E' ratios were risk factors of major cardiovascular complications, while age, LVEDd, LVMI, LAVI, and high E/E' ratios were risk factors of pulmonary edema. The optimal E/E' cut-off value for predicting major cardiovascular complications was 13.0, showing 77.8% sensitivity and 78.5% specificity. Thus, the patient's E/E' ratio is useful for predicting in-hospital major cardiovascular complications after kidney transplantation. We recommend that goal-directed therapy employing E/E' ratio be enacted in kidney recipients with baseline diastolic dysfunction to avert postoperative morbidity
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
김소연(Kim, So Yeon) ORCID logo https://orcid.org/0000-0001-5352-157X
김은정(Kim, Eun Jung) ORCID logo https://orcid.org/0000-0002-5693-1336
장수연(Chang, Su Yon)
최용선(Choi, Yong Seon) ORCID logo https://orcid.org/0000-0002-5348-864X
허규하(Huh, Kyu Ha) ORCID logo https://orcid.org/0000-0003-1364-6989
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