Silent Cardiac Burden: Echocardiographic Abnormalities and Their Predictors in Kidney Transplant Candidates

Background: Echocardiographic abnormalities are common in successful transplant candidates. This retrospective observational study aimed to determine the prevalence of left ventricular hypertrophy, left ventricular systolic dysfunction, diastolic dysfunction, pulmonary hypertension, and their predictors, and to assess their impact on graft function in pretransplant candidates. Methods: The study included all successful transplant candidates older than 14 who had a baseline echocardiogram. Binary logistic regression models were constructed to identify factors associated with left ventricular hypertrophy, left ventricular systolic dysfunction, diastolic dysfunction, and pulmonary hypertension. Results: Out of 259 patients, left ventricular hypertrophy was present in 64% (166), 12% (31) had left ventricular systolic dysfunction, 27.5% (71) had diastolic dysfunction, and 43.5% (107) had pulmonary hypertension. Independent predictors of left ventricular hypertrophy included male gender (odds ratio [OR]: 2.51; 95% CI: 1.17–5.41 p = 0.02), pulmonary hypertension (OR: 2.07; 95% CI: 1.11–3.86; p = 0.02), diastolic dysfunction (OR: 2.47; 95% CI: 1.29–4.73; p = 0.006), and dyslipidemia (OR: 1.94; 95% CI: 1.07–3.53; p = 0.03). Predictors for left ventricular systolic dysfunction included patients with diastolic dysfunction (OR 3.3:95% CI: 1.41–7.81; p = 0.006), and family history of coronary artery disease (OR: 4.50;95% CI: 1.33–15.20; p = 0.015). Peritoneal dialysis was an independent predictor for diastolic dysfunction (OR 10.03;95%1.71-58.94, P 0.011). The presence of left ventricular hypertrophy (OR 3.32, 95% CI 1.05–10.55, p = 0.04) and mild to moderate or moderate to severe mitral regurgitation (OR 4.63, 95% CI 1.45–14.78, p = 0.01) were significant factors associated with pulmonary hypertension. These abnormalities had no significant impact on estimated glomerular filtration at discharge, 6 months, 1 year, or 2 years post-transplant. Conclusion: Significant echocardiographic abnormalities persist in a potential transplant candidate despite cardiac clearance. Understanding the risk factors associated with these abnormalities may help clinicians address these factors pre- and post-transplant to achieve better outcomes.