Early effects of kidney transplantation on the heart - A cardiac magnetic resonance multi-parametric study

Manvir K Hayer, Ashwin Radhakrishnan, Anna M Price, Shanat Baig, Boyang Liu, Charles J Ferro, Gabriella Captur, Jonathan N Townend, James C Moon, Nicola C Edwards, Richard P Steeds

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)
118 Downloads (Pure)

Abstract

Increased native myocardial T1 times in chronic kidney disease (CKD) may be due to diffuse interstitial myocardial fibrosis (DIF) or due to interstitial edema/inflammation. Concerns relating to nephrogenic systemic fibrosis with gadolinium-based contrast agents (GBCA) limit their use in end-stage kidney disease (ESKD) to measure extracellular volume (ECV) and characterise myocardial fibrosis. This study aimed to examine stability of myocardial T1 and T2 times before, and within 2 months after kidney transplantation; a time frame when volume status normalises but myocardial remodelling is unlikely to have occurred, and to compare these with ECV using GBCA after transplantation. Twenty-four patients with ESKD underwent serial cardiovascular magnetic resonance imaging, including T1 and T2 mapping. GBCA was administered on follow-up provided eGFR was >30 ml/min/1.73 m2. Eighteen age- and sex-matched controls were studied at one timepoint. ECV (ECV 28 ± 2% vs. 24 ± 2%, p = 0.001) and T2 times were higher in ESKD compared to controls. After transplantation, septal T1 times increased (MOLLI 985 ms ± 25 vs. 1002 ms ± 30, p = 0.014; ShMOLLI 974 ms ± 39 vs. 992 ms ± 33, p = 0.113), LV volumes reduced (LVEDvol indexed 79 ± 24 vs. 63 ± 20 ml/m2, p = 0.005) but LV mass was unchanged (LV mass index 89 g/m2 ± 38 to 83 g/m2 ± 23, p = 0.141). T2 times did not change after transplantation. Both ECV and myocardial T1 times are elevated in ESKD, supporting the theory that elevated T1 times are due to DIF, although a contribution from myocardial edema cannot be fully excluded. The lack of any fall in T1 or T2 times after transplantation suggests that myocardial T1 times are a stable measure of DIF in CKD.

Original languageEnglish
Pages (from-to)272-277
Number of pages6
JournalInternational Journal of Cardiology
Volume293
Early online date4 Jun 2019
DOIs
Publication statusPublished - 15 Oct 2019

Keywords

  • myocardial fibrosis
  • uremic cardiomyopathy
  • kidney transplantation
  • multiparametric T1/T2 mapping
  • Myocardial fibrosis
  • Multiparametric T1/T2 mapping
  • Uremic cardiomyopathy
  • Kidney transplantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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