CHANGES IN LEFT-VENTRICULAR MASS AND FILLING AFTER RENAL-TRANSPLANTATION ARE RELATED TO CHANGES IN BLOOD-PRESSURE - AN ECHOCARDIOGRAPHIC AND PULSED DOPPLER STUDY

To examine changes in left ventricular (LV) mass and function (diastol ic and systolic) after successful renal allograft transplantation (RT) , we prospectively studied 30 patients(19 men, 11 women, aged 37 +/- 1 3 years) by M-mode, two-dimensional and pulsed Doppler echocardiograph y at the time of surgery and 10 +/- 1.8 months later. At the time of t ransplantation all patients had been undergoing dialysis (4 peritoneal dialysis, 26 hemodialysis) for 2.5 +/- 3.2 years. A hematocrit of les s than or equal to 30% was present in 26 patients. After RT the mean h ematocrit increased from 26 +/- 4 to 40 +/- 7 (p < 0.01), whereas syst olic, diastolic and mean blood pressure (BP) remained unchanged. The L V mass index (LVMI) decreased from 201 +/- 56 to 171 +/- 41 g/m(2), (p < 0.01); LV diastolic diameter corrected by body surface area (LVDDI) decreased from 298 +/- 38 to 279 +/- 35 (p < 0.01) and the LV end-dia stolic volume index (LVEDVI) from 72 +/- 18 to 63 +/- 15 (p < 0.01). T here were no changes in LV fractional shortening or LV end systolic wa ll stress. Peak late transmitral velocity (A wave) decreased from 77 /- 16 to 68 +/- 12 cm/s (p < 0.01) with no changes in other Doppler-de rived indexes of diastolic function. No fistula patency influence on c hanges in LV mass and function was found. After RT, BP decreased in 21 patients from 150 +/- 20 to 132 +/- 15 (p < 0.001; group I) and incre ased in 9 patients from 130 +/- 14 to 153 +/- 16 (p < 0.05, group II). Patients in group I suffered a reduction in LVMI (p < 0.001), LV end- diastolic diameter (p < 0.05), LVDDI (p < 0.001); LV end-diastolic vol ume (p < 0.05); LVEDVI (p < 0.01); cardiac index (p < 0.05), and peak late transmitral velocity (p < 0.01), but no changes in group-II patie nts were observed. We concluded that BP is a major determining factor with regard to changes in LV hypertrophy and function following RT. LV mass and volumes can be expected to decrease after RT in patients wit h BP reduction.