BACKGROUND: Preventing major adverse cardiovascular events (MACE) after kidney transplantation motivates pre-transplant cardiac evaluation that includes two-dimensional transthoracic echocardiography (TTE). The relationship of relative wall thickness (RWT) to left ventricular mass index (LVMI) in predicting post-transplant MACE is unclear.
MATERIAL AND METHODS: In this multi-ethnic Canadian single-center cohort study, we identified 1063 adults undergoing pre-transplant TTE within 1 year pre-transplant and with minimum 6 months of post-kidney transplant follow-up for MACE, defined as a composite of coronary revascularization, myocardial infarction, stroke, and cardiac death. Left ventricular hypertrophy (LVH, >131 g/m² in men and >100 g/m² in women) and increased RWT (>0.45) were a priori used to define normal (no LVH, normal RWT), concentric remodeling (no LVH, increased RWT), eccentric hypertrophy (LVH, normal RWT), and concentric hypertrophy (LVH, increased RWT).
RESULTS: There were 134 MACE over 3577 patient-years of post-transplant follow-up. Both LVH (HR 1.58, p=0.022) and high RWT (HR 1.44, p=0.041) predicted MACE in multivariate survival regression analysis independently of common pre-transplant MACE risk factors. Concentric remodeling, concentric hypertrophy, and eccentric hypertrophy all increased the risk for MACE (4.44, 5.05, and 5.55 events per 100 patient-years, respectively) versus normal echocardiography (2.71 events per 100 patient-years, all p<0.05 for difference). In Cox interactive regression analysis, LVMI and RWT were independently associated with MACE (p=0.015, p=0.025) and significantly interacted (p=0.008).
CONCLUSIONS: LV geometric parameters beyond LVH alone can assist post-transplant prognostication in kidney transplant candidates.

Keywords: Cardiovascular Diseases, Echocardiography, Hypertrophy, Left Ventricular, Patient Outcome Assessment