Long term outcome of asymptomatic kidney transplantation recipients with chronotropic incompetence - A perspective study over 8 Years
Becky My Ma1, Maggie KM Ma1, David CW Siu1, Desmond YH Yap1, Maggie MY Mok1, Lorraine PY Kwan1, Gary CW Chan1, Tak Mao Chan1.
1Medicine, Queen Mary Hospital, Hong Kong, People's Republic of China
Introduction: Chronotropic incompetence (CI) has been accepted as an independent predictor of cardiovascular event and overall mortality. We previously reported that CI was associated with poorer exercise tolerance and greater left ventricular mass in asymptomatic kidney transplant recipients. This study aimed to investigate the long term outcome of kidney transplantation recipients with chronotropic incompetence
Materials and Methods: All recruited patients underwent transthoracic echocardiogram and treadmill stress test using modified Bruce protocol. CI was defined by either a low percent heart rate reserve achieved or failure to achieve 85% maximal age-predicted heart rate. Left ventricular hypertrophy (LVH) was defined according to American Society of Echocardiography classification.
Results and Discussion: 38 renal transplant recipients (21 male and 17 female, mean age 51.7±8.8 years), were followed for median of 9.2 years (interquartile range 8.7-9.3 years). 10 (47.4%) had CI alone (LVH-/CI+) and 7 (18.4%) had CI with commitment LVH (LVH+/CI+). 3 more (7.9%) had LVH alone but no CI (LVH+/CI-). 18 (47.4%) had neither CI nor LVH. 7 patients died during follow-up. Causes of death were infection (n=3), cardiovascular (n=1), malignancy (n=1) and unknown (n=2). The 5-year patient survival of LVH+/CI+, LVH-/CI+ were both 100%, whereas that of LVH+/CI- and LVH-/CI- were 66.7%, and 94% respectively (Figure 1A). 3 patients had graft failure during follow-up. Causes of graft failure were diabetic nephropathy (n=1), IgA nephropathy (n=1) and death with functional graft (n=1). The 5-year patient survival of LVH+/CI+, LVH-/CI+ were 85.7% and 90%, whereas that of LVH+/CI- and LVH-/CI- were 66.7% and 100% respectively (Figure 1B).
Conclusion: Asymptomatic kidney transplantation recipients with chronotropic incompetence had excellent long term graft and patient survival. Presence of LVH adversely impact on survival outcome.
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