Tissue Doppler Imaging and Intima-Media Thickness as Noninvasive Methods of Cardiovascular Risk Stratification in Patients After Kidney Transplantation

• Cardiovascular disease is the most prevalent cause of death in patients with chronic kidney disease and after kidney transplantation.
• Echocardiography with TDI, strain, and strain rate are new methods that provide a precise measurement of LV wall motion.
• Kidney transplant recipients show significant alterations in LV longitudinal myocardial function parameters estimated by strain and strain rate assessed by TDI.
• Conventional echocardiographic parameters (LV mass index, maximal wall thickness, and systolic LV diameter), together with TDI examination and IMT measured before renal transplantation, may improve further risk stratification.

BackgroundCardiovascular complications, including coronary artery disease and chronic heart failure, are the leading causes of death in patients with chronic kidney disease. New echocardiographic techniques, such as tissue Doppler imaging (TDI) with strain and strain rate, are noninvasive, easy-to-perform methods of the estimation of left ventricular (LV) systolic and diastolic function. The aim of the study was to analyze the utility of new noninvasive methods of cardiovascular risk stratification in patients after kidney transplantation.MethodsWe included 43 consecutive kidney transplant (KT) recipients, with 30 healthy subjects constituting the control group in the study. We evaluated LV morphology and LV systolic and diastolic function by means of echocardiography with TDI and intima-media thickness by ultrasonography of the carotid arteries.ResultsLV mass index was significantly higher in transplanted patients, and both mitral inflow E/A and Em/Am ratios from pulsed myocardial imaging were significantly lower in the KT group as compared with the control group. The systolic wave of TDI at the basal segments was much lower in KT patients than in the control patients (P < .05). The mean value of strain rate was reduced in KT recipients as compared with the control patients. IMT was significantly higher in KT recipients.ConclusionsEchocardiography with TDI provided more accurate information about systolic and diastolic LV function. KT recipients showed significant alterations in LV longitudinal myocardial function parameters estimated by strain and strain rate. Strain and strain rate are noninvasive methods, easy to repeat, and valuable for detecting myocardial LV dysfunction in asymptomatic KT recipients.