Evaluation of cardiac functions by speckle tracking echocardiography before and after renal transplantation in patients with stage 5 chronic kidney disease

The incidence of structural heart disease and related deaths are high in patients with chronic kidney disease (CKD), especially those with end-stage renal disease (ESRD) requiring dialysis. Compared with hemodialysis, renal transplantation (RT) reduces the risk of cardiovascular death but there are conflicting results in the literature regarding the status of cardiac functions after RT. Speckle tracking echocardiography (ST-ECHO), a new technique, can evaluate the velocity and movement of the myocardium at multiple points simultaneously. The analysis of deformation is performed according to different components of myocardial contraction (longitudinal, circumferential and radial) and cardiac pathologies can be detected in the early period. The aims of this study are to compare the possible effects of RT on cardiac morphology, systolic and diastolic functions, left ventricular mass, and left ventricular mass index in patients with CKD who underwent RT by ST-ECHO and to detect changes after RT. This study was planned as a prospective-cohort and as a single-center study. Descriptive, biochemical, and echocardiographic data of 30 patients with CKD were compared before and 3 months after RT. Biochemically, patients' blood urea nitrogen (BUN), creatinine, glomerular filtration rate (GFR), hemogram, and protein in the spot urine were recorded in the last week before RT and three months after RT. Echocardiographically; conventional, Doppler and ST-ECO measurements of the patients during the last week before RT and at 3 months after RT were analyzed. Left ventricular circumferential strain and global longitudinal strain values were analyzed as STE-ECO and the results were recorded. When the compared with pre-transplant values; left ventricular end-diastolic and end-systolic (LVED and LVES, respectively) dimensions, left ventricular mass index and myocardial perfusion index parameters increased in the 3rd month after RT, whereas a significant increase was observed in left ventricular ejection fraction parameters. When speckle tracking was performed by echocardiography; significant increase in global longitudinal strain and left ventricular circumferential strain parameters were observed. Despite of normal monitored parameters in the conventional and Doppler echocardiographic parameters, there is a subclinical affection in the ESRD. There was a correlation between improvements in kidney disease with strain echocardiography parameters in the post-RT patients. These results show the importance of RT, which is considered to be the most effective treatment for ESRD.