Association of Pre‐Transplant Left Ventricular Longitudinal Strain With Long‐Term Cardiovascular Outcomes Following Kidney Transplantation

PURPOSE: Cardiovascular disease (CVD) remains the leading cause of death among kidney transplant recipients (KTRs). Current guidelines recommend using left ventricular global longitudinal strain (GLS) for the early identification of cardiac dysfunction, but its value in KTRs has not been well studied. METHODS: We performed a single-center retrospective cohort study of adult KTRs who underwent KT between January 2015 and January 2024 and had an adequate-quality pre-transplant echocardiogram. Patients without follow-up at our institution or with atrial fibrillation were excluded. GLS was measured using vendor-independent two-dimensional speckle-tracking software, with abnormal GLS defined as absolute GLS < 16% (lower absolute strain magnitude), with higher values indicating better systolic function. Patients were divided into normal GLS (NGLS) or abnormal GLS (AbGLS) groups. The primary outcome was major adverse cardiovascular events (MACE), defined as cardiovascular death, acute coronary syndrome, stroke, hospitalization for heart failure, or major arrhythmia. Kaplan-Meier survival curves and Cox proportional hazards models were constructed for statistical analysis. RESULTS: Of 518 screened KTRs, 341 met the study criteria. Compared with NGLS patients (n = 159), AbGLS patients (n = 182) were older (55.1 vs. 51.5 years) and had a significantly higher prevalence of hypertension, diabetes mellitus, and coronary artery disease. Over a mean follow-up of 52.7 ± 28.3 months, Kaplan-Meier analysis demonstrated a significantly higher cumulative incidence of MACE in the AbGLS group, with a 5-year incidence of 27.1% versus 9.4% in NGLS (log-rank p = 0.002). In multivariable Cox regression adjusted for confounding variables identified from univariate regression, GLS was independently associated with MACE (adjusted HR 0.94; 95% CI 0.88-1.00; p = 0.04), whereas left ventricular ejection fraction was not. CONCLUSION: In this retrospective single-center study, GLS was independently associated with MACE in KTRs, supporting a potential role for GLS in cardiovascular risk assessment in KT candidates.