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Prevalence and Management of cardiovascular disease in patients with prior renal transplantation
Session:
Posters (Sessão 1 - Écran 3) - Doença Cardiovascular em Populações Especiais 1
Speaker:
Rita Amador
Congress:
CPC 2022
Topic:
K. Cardiovascular Disease In Special Populations
Theme:
30. Cardiovascular Disease in Special Populations
Subtheme:
30.9 Renal Failure and Cardiovascular Disease
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Rita r Amador; Sérgio Maltês; Bruno ml Rocha; Gonçalo jl Cunha; Catarina Mateus; Carlos Aguiar; André Weigert; Miguel Mendes
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Background</u>: Kidney transplantation (KT) is the preferred treatment for end-stage kidney disease and approximately 500 KT are performed annually in Portugal. Yet, despite successful KT rates, cardiovascular disorders (CVD) remain one of the major causes of death and allograft failure. Several transplantation-specific and cardiovascular (CV) risk factors pertain a higher risk for CVD. Our goal was to assess the prevalence of CV risk factors and structural heart disease in a KT population and assess the use of Optimal Medical Therapy (OMT) in this population. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Methods</u>: We conducted a single-center retrospective study enrolling all 324 KT patients between Jan-15 and Jul-21. Those without 2D transthoracic echocardiogram (TTE) after transplantation were excluded. Patient data regarding cardiovascular (CV) risk factors or previous CVD were obtained from electronic clinical records. Structural heart disease was defined by the presence of at least one of the following on TTE: left ventricle ejection fraction (LVEF) <50%; at least moderate valvular heart disease (VHD) or previous valvular heart surgery; right ventricular dysfunction as per the EACVI definition.</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="color:#222222">Results</span></u><span style="color:#222222">: A total of 124 patients were included (mean age 58±11 years; 64% male; median time on renal replacement therapy prior to KT 5.9 [3.8-7.4] years; mean left ventricle ejection fraction [LVEF] by TTE 56±8%). A high prevalence of CV risk factors was observed: 103 patients (83%) were hypertensive; 25 (20%) with diabetes; 52 (42%) with dyslipidemia; 34 (27%) with current or previous smoking. Out of the hypertensive patients, 7 (2%) were prescribed ACEi, and other anti-hypertension drugs were preferred. Overall, 31 patients (25%) had established structural heart disease: 13 (10%) with LVEF <50%; 5 patients (4%) with right ventricular dysfunction, 11 (7%) had valvular disease that was at least moderate, 3 (2.5%) were submitted to surgical (aortic) valve replacement after KT. Moreover 97 (78%) had an indexed left atrial volume >35mL/m<sup>2</sup>, 75 (61%) had pulmonary hypertension (defined as pulmonary artery systolic pressure >35mmHg) and 74 had left ventricle (LV) hypertrophy. Out of the patients with LVEF<50%, 3 (21%) received Renin-Angiotensin-Aldosterone System inhibitors (RAASi), 1 (7%) received a Mineralocorticoid Antagonist, 8 (57%) received a beta-blocker and 1 (7%) received a SGLT2 inhibitor. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="color:#222222">Conclusion</span></u><span style="color:#222222">: </span>In a cohort of KT patients, structural heart disease was common and over what one would expect in the general population. <span style="color:#222222">Management of LV dysfunction may be suboptimal with a significant proportion of patients not receiving disease modifying treatment. </span>Our findings suggest that structural heart disease in KT recipients should be routinely performed, in order to promote early detection and facilitate treatment optimization. </span></span></p>
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